Monitoring
An appropriate follow-up is to ask the patient to return in 4 to 6 weeks if pain is unimproved. If pain is progressive or its nature changes to include red-flag symptoms, then more urgent follow-up is necessary. Patients who are at medium and high risk of chronic pain may benefit from earlier physical therapy.[197]
If at 4 to 6 weeks symptoms have not improved, imaging and referral to a physical therapist and/or a spine specialist should be considered. Specialists typically employ a multidisciplinary approach and are well equipped for monitoring pain medications and physical therapies. They can provide comprehensive diagnostic workup and refer patients to additional services (e.g., for pain psychology, surgical interventions).
When a patient does not respond to initial standard care, other measures that have some supportive evidence can be tried (e.g., multidisciplinary rehabilitation).
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