My Favourite Back Pain Diagnosis Tool Just Changed (Not For The Better)
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For years I've used the CORE Low Back Tool from the Centre for Effective Practice. They've changed it and I love the content but I have a few thoughts about the new format.
Overall it's a fantastic tool. I was lucky enough to see one of its inventors speak at a conference (Dr. Hamilton Hall) and still remember a great pearl from that lecture:
If the pain is back predominant (not leg), and intermittent (not constant) it's almost never something serious.
So I ask my patients if they can find a position, even for a moment, that takes away all their pain.
How I Use It
After going through the history, red flags, and exam, I typically print the PDF, pages 2 & 3, and run through the tool with the patient, showing their diagnosis as well as the management options. I then print the exercise brochure...conveniently linked in the PDF. Then I use the notes section to explain the different treatments I recommend, and advise them on what to use e.g. Yoga, massage, low back chiropractic... And don't combine NSAIDs.
Some of the Changes in the new version
Tylenol has been removed... The evidence does not support it for back pain.
Clearer info on Cauda Equina "Cauda equina syndrome is defined by clinical features, not imaging findings alone. Imaging that reports compression of the cauda equina does not imply cauda equina syndrome in the absence of clinical symptoms. Please note, some symptoms may be absent"
Addition of "Possible inflammatory spondyloarthritis"
Format Changes
While I appreciate the above, they've gotten rid of the .PDF version. The entire form is now embedded on their website and buried in hidden click menus. Hopefully they restore the .PDF to its former greatness, so I can continue to offer it to my patients who are often in immeasurable pain... And reassure them that despite the severe pain, they likely have nothing seriously wrong.
Source: https://cep.health/clinical-products/low-back-pain/ Image Credit: Photo by Sasun Bughdaryan on Unsplash
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