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Back & Neck Pain


These are guidelines for most patients most of the time. Like all guidelines, there are exceptions. Acute back pain is for < 6 weeks, chronic > 6 weeks

Spinal Pathways Summary for Back and Neck Pain

Acute back pain is defined as < 6 weeks & chronic back pain > 6 weeks

MRI for low back pain (without serious neurological deficit or red flags eg indicators of infection or neoplasia) does NOT affect clinical outcome. In most cases with back pain (especially low back pain), the MRI should be considered a prelude to surgery, ie to guide the surgeon to a surgical target.

Spinal XR is usually not helpful, unless looking for osteoporotic collapse in the elderly

If you need to discuss a patient, ring Neurosurgery registrar on bleep 2300.

On a Wednesday ring T&O registrar on bleep 2699. If in doubt, ask



Pathways for Back and Neck Pain



At present all MRIs (via PACS) have been connected across the West Midlands. So, if necessary, a Neuro/Spinal T&O surgeon can view the scan carried out in a referring hospital.

These include UHCW, GEH (Nuneaton), SWFT (Warwick), Worcester Royal Hospital and Alexandra Hospital (Redditch).

GPs: it is important to be aware of addictive nature of opiates and pain modulating drugs (gabapentin and pregabalin). These should only be prescribed for short periods.


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Coventry Guidance  
Referral to Adult Musculoskeletal Service – Coventry

If initial conservative GP management has failed refer to Adult Physiotherapy Musculoskeletal Service via NHS E-referral for initial physio triage and to be assessed for a treatment programme including:

  • Exercise therapy
  • Manual Therapy
  • Acupuncture
  • Self-management advice and education

If neurological symptoms refer urgently to Adult Physiotherapy Musculoskeletal Service

If diagnostic imaging is required the patient will be referred and the findings discussed with the patient.

If appropriate the patient can be referred to Neurosurgery, Pain Clinic or Spinal Orthopaedics. Alternatively patients can be discussed in the Virtual Clinic. Here more complex cases are reviewed with an orthopaedic spinal surgeon and surgery or spinal injections can be considered.

Rugby & South Warwickshire Guidance  

If initial conservative GP management has failed refer to Rugby Adult Physiotherapy Musculoskeletal Service for assessment and management.

The Rugby Physiotherapy Service is administered by South Warwickshire NHS Foundation Trust.

The referral form for Rugby physio can be found on the right hand panel.

Physiotherapy contact number for all clinics:
Tel: 01926 608068

Patients can refer themselves for musculoskeletal (only) physiotherapy using this self-referral form.

The Physiotherapy Service provides in-patient and outpatient services at Warwick, Stratford, Leamington & Ellen Badger Hospitals, as well as outpatient services in a variety of clinics across South Warwickshire, listed below:

  • Alcester Primary Care Centre, Fields Park Drive, Alcester, B49 6QR
  • Bidford Health Centre, High Street, Bidford on Avon, B50 4BQ
  • Ellen Badger Hospital, Stratford Road, Shipston Upon Stour, CV36 4AX
  • Henley in Arden Surgery, Prince Harry Road, Henley, B95 5JD
  • Kenilworth Clinic, Smalley Place, Kenilworth, CV8 1QG
  • Kineton Surgery, The Old School, Market Square, Kineton, CV35 0LP
  • Leamington Spa Rehabilitation Hospital, Heathcote Lane, Warwick CV34 6SR
  • MEON Medical centre, Goose Lane, Lower Quinton, CV37 8TA
  • Southam Clinic, Pendyke Street, Southam, CV47 1PF
  • Studley Poole Medical centre, Studley B80 7QU
  • Stratford Upon Avon Hospital, Arden Street, Stratford Upon Avon, CV37 6NX
  • The Hospital of St Cross, Barby Road, Rugby, CV22 5X

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