Low back and radicular pain: a pathway for care developed by the British Pain Society

Br J Anaesth. 2013 Jul;111(1):112-20. doi: 10.1093/bja/aet172.


These consensus guidelines aim to provide an overview of best practice for managing chronic spinal pain reflecting the heterogeneity of low back pain. Most guidelines have covered only one aspect of spinal care and thus have been divisive and potentially worsened the quality of care. Additionally, some of the evidence base is subjective and of poor quality. The British Pain Society low back pain pathway has reached across all disciplines and involved input from patients. It is recognized, however, that there is an urgent need for further good-quality clinical research in this area to underpin future guidelines. Considerable work is still needed to clarify the evidence; however, foundations have been laid with this pathway. Key features include: risk stratification; clarification of intensity of psychological interventions; a logical progression for the management of sciatica; and decision points for considering structural interventions such as spinal injections and surgery.

Keywords: analgesics, opioid; injections, epidural; injections, spinal; low back pain; radiculopathy; sciatica; zygapophyseal joint.

Publication types

  • Practice Guideline
  • Review

MeSH terms

  • Analgesics, Opioid / therapeutic use
  • Chronic Pain / drug therapy
  • Humans
  • Injections, Epidural / methods
  • Injections, Spinal / methods
  • Low Back Pain / drug therapy*
  • Radiculopathy / drug therapy*
  • Sciatica / drug therapy
  • Societies, Medical
  • United Kingdom


  • Analgesics, Opioid