1. This Back in Focus resource was developed and funded by AbbVie. Date of preparation: June 2015; AXHUR150807q SUMMARY Assessment, Management and Referral

2. What we have covered What to look for when diagnosing back pain ‒ Distinguishing mechanical vs inflammatory back pain Appropriate assessment criteria for patients presenting with back pain Appropriate and timely referral of patients suffering with back pain

3. Comparison of inflammatory and mechanical back pain 1. Sieper, J et al. Ann Rheum Dis 2009; 68:784-788 2. Chien, JJ and Bajwa, ZH. Current pain and headache reports 2008; 12:406-411 IBP Age at onset <40 years Insidious onset; less likely to be acute Pain improves with exercise Pain does not improve with rest Pain at night that may wake patient during second half of the night Morning stiffness >30 minutes MBP Age at onset; any age Variable onset; may be acute Pain may worsen with movement Pain often improves with rest

4. 1 1 1 1 ASAS criteria for identifying inflammatory back pain 1. Sieper et al. Ann Rheum Dis. 2009; 68:784–788.

5. 1 1 1 1 ASAS criteria for identifying inflammatory back pain 1. Sieper et al. Ann Rheum Dis. 2009; 68:784–788. Inflammatory back pain requiring further investigation is usually indicated if the answer is ‘yes’ to 4 or more of these parameters

6. Inflammatory back pain Who to refer to Mechanical back pain Braun, J et al. Ann Rheum Dis 2011; 70:896–904. If IBP is suspected refer to rheumatology If MBP is suspected refer to local musculoskeletal interface service If MBP is suspected refer to local musculoskeletal interface service

7. Back pain is a common reason for primary care consultations It is important to be able to distinguish between back pain of mechanical and inflammatory origin as the referral pathways and treatments differ ‘Red flags’ should be investigated immediately Summary