* make a specific clinical examination and history, including the evaluation of psycho-social risk factors to identify the presence of radiculopathies, vertebral stenosis or back pain without any specific cause
* do not perform any diagnostic or X-ray test for the subjects with non-specific low back pain
* make patients with neurological deficits or when causal diseases are suspected undergo examinations
* use imaging techniques (above all MR) in order to evaluate persistent, radiculopathic or vertebral stenotic pain only if patients are considered as candidates to surgery or epidural injection
* give patients information on prognosis and on self-management
* use paracetamol or NSAIDs as first-choice drugs
* use non-pharmacological therapies for those patients who are not capable to manage low back pain by themselves: spinal manipulations, physical exercises, yoga, cognitive-behavioral therapy, muscular relaxation techniques are all aids which can be of a certain usefulness in these patients.
These rules are based on systematic reviews of evidence, and also affirm the importance of the use of myorelaxant drugs and of tricyclic antidepressants in the treatment of acute pain. As we can see, the use of surgery is not implied, which is the only practicable option in some situations. For the rest, there is nothing new about low back pain.
