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Summary of still valid AHCPR Guide #14 "Findings & Recommendations" Statements (see Strength of Evidence
Recommend against
34 studies
History of cancer/infection (B). “Red Flags” 
Cauda equina syndrome (C). “Red Flags” 
History of significant trauma (C). “Red Flags” 
Psychosocial history (C). 
Focused neurological exam (B).
 Visual Analog Scale (D).
14 studies
Patient education about back problems (B). 
Back school in occupational settings (C).
Back school in non-occupational settings(C).
23 studies
Acetaminophen (C). 
Muscle relaxants(C). 
Opioids, short course(C).
Opioids used >2 wks (C). 
Phenylbutazone (C). 
Oral steroids (C). 
Colchicine (B). 
Antidepressants (C).
42 studies
Manipulation during first month of low back pain without radiculopathy (B).
Manipulation for patients with radiculopathy(C). 
Manipulation questionable for patients with symptoms >1 month (C). 
Self-application heat/cold to back (D) 
Shoe insoles(C). 
Corset for prevention 
 in occupational setting(C).
Manipulation for patients with undiagnosed neurologic deficits (D). 
Prolonged course of manipulation (D). 
Traction (B). 
Transcutaneous Nerve Stimulation TENS (C). 
Biofeedback (C). 
Shoe lifts (D). 
Corset for treatment (D).
26 studies
Epidural steroid injections for radicular pain to avoid surgery( C).
Epidural injections for back pain without radiculopathy (D). 
Trigger point injections (C). 
Ligamentous injections (C). 
Facet joint injections (C). 
Needle acupuncture (D).
Bed Rest  4 studies
Bed rest of 2-4 days for severe radiculopathy (D).
Bed rest > 4 days (B).
20 studies
Temporary reduction of activities that increase mechanical stress on spine as necessary (D). 
Gradual return to normal activities ASAP (B). 
If limited - Low-stress aerobic exercise(C). 
Conditioning exercises for trunk 
 muscles after 2 weeks of limitation (C). 
Exercise quotas(C).
Back specific exercise machines (D). 
Therapeutic stretching of back muscles (D).
14 studies
BP not improving after 1 month: ? Bone scan (C). 
Radiculopathy? Needle EMG and H-reflex tests to clarify nerve root compromise(C). 
? SEP to assess spinal stenosis (C).
EMG for clinically obvious radiculopathy (D). 
Surface EMG and F-wave tests (C). 
Thermography (C).
18 studies
When “Red Flags” for fracture present(C). 
When “Red Flags” for cancer or infection present(C).
Routine use in first month of symptoms in absence of "RED FLAGS "(B). 
Routine oblique views (B).
18 studies
? CT or MRI when strongly suspect Cauda equina, tumor, infection, or fracture C). 
? MRI test of choice for patients with prior back surgery (D). 
Criteria for imaging tests (B).
Myelography or CT-Myelography for preoperative planning (D).
Use of imaging test before one month in absence of "Red Flags"(B). 
14 studies      
Discuss possible surgical options with patients with persistent and severe sciatica and clinical evidence of nerve root compromise after 1 month of conservative therapy (B). 
Standard discectomy and micro-discectomy of similar efficacy in treatment of herniated disc (B). 
Chymopapain, after ruling out allergic sensitivity, acceptable but less efficacious than discectomy for herniated disc(C).
Disc surgery for back pain alone, no "Red Flags," and no nerve root compression (D). 
Percutaneous discectomy, less efficacious than chymopapain (C). 
Surgery for spinal stenosis within the first 3 months of symptoms (D). 
Stenosis surgery by imaging tests rather than Cauda equina syndrome or neuroclaudication (D). 
Fusion without motion & stenosis fracture, dislocation, tumor or infection complications(C).*
Social, economic, and non-physical factors can alter patient’s response to symptoms or care (D).*
Before extensive Evaluations or Treatment Programs, explore patient expectations & non-physical factors (D).
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