| Moderate pain; no neurologic deficit or mild to moderate deficit | Pain medications, muscle relaxants, heat, back precautions; neurology consultation, if deficit; follow-up examination in 2 weeks, if deficit; if symptoms improve, refer to physical therapy (back exercises, "back school"), or back exercises at home |
| Severe pain; no neurological deficit or mild to moderate deficit | Bed rest up to 10 days (depending on pain severity and response to rest), pain medications, muscle relaxants, heat; neurology consultation, if deficit; Follow-up examination in 2 weeks, if deficit; if symptoms improve, physical therapy or home exercises |
| Severe deficit (neurologic, bladder, bowel, sexual) or |
Neurology or neurosurgery consultation and MRI on an urgent basis; if a large-mass lesion is found, refer to a neurosurgeon or orthopedic surgeon |
| Increasing neurologic deficit; severe pain not improved by 1+ week of bed rest | Neurology consultation; MRI or CT; if large-mass lesion found, refer to neurosurgeon or orthopedic surgeon; if no large lesion, up to one more week of bed rest, then refer to physical therapy or home exercises |
| No improvement or incomplete improvement after bed rest, gradual ambulation, physical therapy, and home exercises | MRI or CT if not already done; consider referral to neurologist, neurosurgeon, or orthopedic surgeon; consider epidural steroids |