NHS Lothian Integrated Back Pain Pathway

Intergrated Back Pain Service Home page https://services.nhslothian.scot/IBPS

Service

The NHS Lothian integrated back pain service is a multidisciplinary collaboration. The service is based on the principles of the right care, from the right person, at the right time in the right place.

The service offers a single point of access for patients with routine low back pain/ sciatica/ lumbar stenosis who require referral for their problem following failure to improve with initial primary care management.

Once within the service patients will be able to access all the multidisciplinary services that are required for their problem including physiotherapy, investigation, surgical opinion and pain clinic opinion. There will be no need for patients to return to their GP to seek additional referrals or investigations for the lumbar spine problem. The service is underpinned by agreed pathways, escalation criteria and multidisciplinary clinics.

The service has been designed following consultation with; General Practitioner Services, Neurosurgery Services, Orthopaedic Services, Pain Services, Pharmacy Services, Physiotherapy Services, Radiology Services, Emergency Services and Rheumatology Services.

Orthopaedics.aspx, Neurosurgery.aspx, Neurology.aspx

Who to refer:

All routine cases of low back pain, sciatica, stenosis who have not responded to initial primary care management and do not have the presence of significant red flags
MRI scan is not required at point of referral. If a MRI is indicated as part of a patients management this will be requested within the multi-disciplinary service at the appropriate time for the patient and any intervention that may be required

Patient leaflet: Integrated Low Back Pain Service PIL

NHS Lothian Primary Care Back Pain Decision tool

Who not to refer:

Age <16. Refer to paediatric services
Patients with significant red flags – see referral criteria for further detail here: NHS Lothian Primary Care Back Pain Decision tool
Patients with chronic low back pain with significant psychological component and failed previous conservative and/or surgical management- refer directly to pain management services

Patients with problems in cervical or thoracic regions. Currently these patients will be managed by the traditional routes.

How to refer:

For all cases of routine low back pain/ sciatica/ stenosis refer via SCI Gateway Referral “AHP-Physiotherapy” then choose local site.
This single referral will gain access to the full multidisciplinary NHS Lothian integrated back pain service. Any consequent investigation/ surgical opinion/ pain service referral will be made within the service- the patient will not require to return to their GP. Please include relevant detail on your referral to allow the appropriate initial triage of the patient.