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1995 Physical Examination Clinical signs detected during physical and psychosocial assessment must be interpreted cautiously as many tests lack reliability and validity. *LEVEL III-2: LeBoeuf-Yde et al. 2002; Truchon and Fillion 2000; Knutson 2002; Waddell et al. 1980; Deyo et al. 1992 A full neurological examination is warranted in the presence of lower limb pain and other neurological symptoms. *LEVEL IV: Waddell et al. 1982; McCombe et al. 1989 Ancillary Investigations Plain xrays of the lumbar spine are not routinely recommended in acute non-specific low back pain as they are of limited diagnostic value and no benefits in physical function, pain or disability are observed.

Pain may be an indicator of tissue damage but may also be experienced in the absence of an identifiable cause. The degree of disability experienced in relation to the experience of pain varies; similarly there is individual variation in response to methods to alleviate pain (Eccleston 2001). Effective pain relief is considered a human right derived from these principles (NHMRC 1999): • Unrelieved severe pain has adverse psychological and physiological effects. • Patients should be involved in the assessment and management of their pain.

International Classification of Impairments, Disabilities and Handicaps. WHO: Geneva. Bonica JJ (1953). The Management of Pain. Lea and Febiger: Philadelphia. 22 Evidence-based Management of Acute Musculoskeletal Pain Evidence-based Management of Acute Musculoskeletal Pain Chapter 3 Effective Communication This chapter contains information that is generic to the management of all people with acute musculoskeletal pain. This chapter was developed by the steering committee and the key messages have been developed through consensus.

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