There is uncertainty on the optimal management of acute low back pain. Research over the last 15 years has shown that the most commonly provided primary care interventions such as exercise, spinal manipulation and simple analgesic drugs are not effective at improving pain or disability. In the last few years guidelines have suggested a new approach, where patients are screened using a validated prognostic model and care is targeted to risk strata. This approach holds significant promise to provide more intensive interventions to those that need them most.
The findings from a recently completed randomised controlled trial of targeted pain education (Traeger et al., 2019 JAMA Neurology) will be presented. Evidence from a mediation analysis, nested within the trial will be used to show how the future management of acute low back pain can be optimised.