Can you suggest a patient self-management program for low back pain, including

Assessment: Start with a thorough assessment of the patient's low back pain, including the onset, type, site, pattern, pain radiation, duration, aggravating/relieving factors, previous episodes, associated symptoms, impact on daily activities, and psychological wellbeing. Screen for red flag symptoms suggesting serious underlying causes and perform a physical examination assessing gait, posture, spine tenderness, range of movement, neurological signs, and relevant special tests. Use a risk stratification tool such as the Keele STarT Back tool at first contact to identify risk factors for a prolonged or complex recovery and tailor management accordingly. Avoid routine imaging unless specific pathology is suspected NICE CKS,NICE NG59.

Intervention: Provide patient-tailored advice and information about the nature of low back pain to encourage continuation or resumption of normal activities and keeping active. Self-management strategies include education, advice on maintaining usual activities, and use of local heat for symptom relief if needed. First-line pharmacological treatment for symptom relief includes nonsteroidal anti-inflammatory drugs (NSAIDs), with short-term codeine (with or without paracetamol) as second-line. For people at risk of prolonged recovery or complex cases, offer exercise programmes (biomechanical, aerobic, mind–body, or combinations), manual therapies as adjuncts to exercise, and psychological support such as cognitive behavioural therapy as part of a combined physical and psychological treatment approach. Occupational health assessment should be advised if work adjustments are required NICE CKS,NICE CKS,NICE NG59.

Monitoring: Arrange review if symptoms persist or worsen after 3–4 weeks to reassess for underlying causes and evaluate adherence and response to self-management and drug treatments. Reassess risk factors for a complex recovery and, if chronic low back pain persists despite non-invasive treatments, consider referral to specialist back pain services for further management, including possible procedures such as radiofrequency denervation if indicated. Encourage patients to seek urgent medical review if red flag symptoms arise at any point NICE CKS,NICE CKS,NICE NG59.