Back ألم أسفل الظهر Arabic Bel ağrısı Azerbaijani بئل آغری‌سی AZB Люмбага Byelorussian Лумбаго Bulgarian Lumbàlgia Catalan Hexenschuss German އުނަގަނޑުގައި ރިހުން DV Οσφυαλγία Greek Lumbalgia Spanish

Low back pain

Low back pain
Other namesLower back pain, lumbago
Location of the lumbar region (pink) in relation to the human skeleton
Pronunciation
SpecialtyOrthopedics, rheumatology, rehabilitation medicine
Usual onset20 to 40 years of age[1]
Duration~65% get better in 6 weeks[2]
TypesAcute (less than 6 weeks), sub-chronic (6 to 12 weeks), chronic (more than 12 weeks)[3]
CausesUsually non-specific, occasionally significant underlying cause[1][4]
Diagnostic methodMedical imaging (if red flags)[5]
TreatmentContinued normal activity, non-medication based treatments, NSAIDs[2][6]
Frequency~25% in any given month[7][8]

Low back pain or lumbago is a common disorder involving the muscles, nerves, and bones of the back, in between the lower edge of the ribs and the lower fold of the buttocks. Pain can vary from a dull constant ache to a sudden sharp feeling.[4] Low back pain may be classified by duration as acute (pain lasting less than 6 weeks), sub-chronic (6 to 12 weeks), or chronic (more than 12 weeks).[3] The condition may be further classified by the underlying cause as either mechanical, non-mechanical, or referred pain.[5] The symptoms of low back pain usually improve within a few weeks from the time they start, with 40–90% of people recovered by six weeks.[2]

In most episodes of low back pain a specific underlying cause is not identified or even looked for, with the pain believed to be due to mechanical problems such as muscle or joint strain.[1][4] If the pain does not go away with conservative treatment or if it is accompanied by "red flags" such as unexplained weight loss, fever, or significant problems with feeling or movement, further testing may be needed to look for a serious underlying problem.[5] In most cases, imaging tools such as X-ray computed tomography are not useful or recommended for low back pain that lasts less than 6 weeks (with no red flags) and carry their own risks.[9] Despite this, the use of imaging in low back pain has increased.[10] Some low back pain is caused by damaged intervertebral discs, and the straight leg raise test is useful to identify this cause.[5] In those with chronic pain, the pain processing system may malfunction, causing large amounts of pain in response to non-serious events.[11] Chronic non-specific low back pain (CNSLBP) is a highly prevalent musculoskeletal condition that not only effects the body, but also a person's social and economic status. It would be greatly beneficial for people with CNSLBP to be screened for genetic issues, unhealthy lifestyles and habits, and psychosocial factors on top of musculoskeletal issues. [12]

The symptoms of low back pain usually improve within a few weeks from the time they start, with 40–90% of people recovered by six weeks.[2] Normal activity should be continued as much as the pain allows.[2] Initial management with non-medication based treatments is recommended.[6] Non–medication based treatments include superficial heat, massage, acupuncture, or spinal manipulation.[6] If these are not sufficiently effective, NSAIDs are recommended.[6] A number of other options are available for those who do not improve with usual treatment. Opioids may be useful if simple pain medications are not enough, but they are not generally recommended due to side effects,[13] including high rates of addiction, accidental overdose and death.[14] Surgery may be beneficial for those with disc-related chronic pain and disability or spinal stenosis.[15][16] No clear benefit of surgery has been found for other cases of non-specific low back pain.[15] Low back pain often affects mood, which may be improved by counseling or antidepressants.[17][18] Additionally, there are many alternative medicine therapies, but there is not enough evidence to recommend them confidently.[19] The evidence for chiropractic care[20] and spinal manipulation is mixed.[19][21][22][23]

Approximately 9–12% of people (632 million) have low back pain at any given point in time,[24] and nearly 25% report having it at some point over any one-month period.[7][8] About 40% of people have low back pain at some point in their lives,[7] with estimates as high as 80% among people in the developed world.[25] Low back pain is the greatest contributor to lost productivity, absenteeism, disability and early retirement worldwide.[24] Difficulty most often begins between 20 and 40 years of age.[1] Men and women are equally affected.[4] Low back pain is more common among people aged between 40 and 80 years, with the overall number of individuals affected expected to increase as the population ages.[7]

Video explanation
  1. ^ a b c d Casazza BA (February 2012). "Diagnosis and treatment of acute low back pain". American Family Physician. 85 (4): 343–350. PMID 22335313.
  2. ^ a b c d e da C Menezes Costa L, Maher CG, Hancock MJ, McAuley JH, Herbert RD, Costa LO (August 2012). "The prognosis of acute and persistent low-back pain: a meta-analysis". CMAJ. 184 (11): E613–E624. doi:10.1503/cmaj.111271. PMC 3414626. PMID 22586331.
  3. ^ a b Koes BW, van Tulder M, Lin CW, Macedo LG, McAuley J, Maher C (December 2010). "An updated overview of clinical guidelines for the management of non-specific low back pain in primary care". European Spine Journal. 19 (12): 2075–2094. doi:10.1007/s00586-010-1502-y. PMC 2997201. PMID 20602122.
  4. ^ a b c d "Low Back Pain Fact Sheet". National Institute of Neurological Disorders and Stroke. 3 November 2015. Archived from the original on 4 March 2016. Retrieved 5 March 2016.
  5. ^ a b c d Manusov EG (September 2012). "Evaluation and diagnosis of low back pain". Primary Care. 39 (3): 471–479. doi:10.1016/j.pop.2012.06.003. PMID 22958556.
  6. ^ a b c d Qaseem A, Wilt TJ, McLean RM, Forciea MA, Denberg TD, Barry MJ, et al. (April 2017). "Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians". Annals of Internal Medicine. 166 (7): 514–530. doi:10.7326/M16-2367. PMID 28192789.
  7. ^ a b c d Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, et al. (June 2012). "A systematic review of the global prevalence of low back pain". Arthritis and Rheumatism. 64 (6): 2028–2037. doi:10.1002/art.34347. PMID 22231424.
  8. ^ a b Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. (December 2012). "Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010". Lancet. 380 (9859): 2163–2196. doi:10.1016/S0140-6736(12)61729-2. PMC 6350784. PMID 23245607.
  9. ^ American Academy of Family Physicians, Choosing Wisely (2023). "Imaging for Low Back Pain". www.aafp.org. Retrieved 21 July 2023.
  10. ^ Deyo RA, Mirza SK, Turner JA, Martin BI (2009). "Overtreating chronic back pain: time to back off?". Journal of the American Board of Family Medicine. 22 (1): 62–68. doi:10.3122/jabfm.2009.01.080102. PMC 2729142. PMID 19124635.
  11. ^ Salzberg L (September 2012). "The physiology of low back pain". Primary Care. 39 (3): 487–498. doi:10.1016/j.pop.2012.06.014. PMID 22958558.
  12. ^ Herrero P, Val P, Lapuente-Hernández D, Cuenca-Zaldívar JN, Calvo S, Gómez-Trullén EM (20 February 2024). "Effects of Lifestyle Interventions on the Improvement of Chronic Non-Specific Low Back Pain: A Systematic Review and Network Meta-Analysis". Healthcare (Basel, Switzerland). 12 (5): 505. doi:10.3390/healthcare12050505. ISSN 2227-9032. PMC 10931043. PMID 38470617.
  13. ^ Cite error: The named reference :5 was invoked but never defined (see the help page).
  14. ^ Cite error: The named reference :6 was invoked but never defined (see the help page).
  15. ^ a b Manusov EG (September 2012). "Surgical treatment of low back pain". Primary Care. 39 (3): 525–531. doi:10.1016/j.pop.2012.06.010. PMID 22958562.
  16. ^ Chou R, Baisden J, Carragee EJ, Resnick DK, Shaffer WO, Loeser JD (May 2009). "Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline". Spine. 34 (10): 1094–1109. doi:10.1097/BRS.0b013e3181a105fc. PMID 19363455. S2CID 1504909.
  17. ^ Miller SM (September 2012). "Low back pain: pharmacologic management". Primary Care. 39 (3): 499–510. doi:10.1016/j.pop.2012.06.005. PMID 22958559.
  18. ^ Henschke N, Ostelo RW, van Tulder MW, Vlaeyen JW, Morley S, Assendelft WJ, Main CJ (July 2010). "Behavioural treatment for chronic low-back pain". The Cochrane Database of Systematic Reviews. 2011 (7): CD002014. doi:10.1002/14651858.CD002014.pub3. PMC 7065591. PMID 20614428.
  19. ^ a b Marlowe D (September 2012). "Complementary and alternative medicine treatments for low back pain". Primary Care. 39 (3): 533–546. doi:10.1016/j.pop.2012.06.008. PMID 22958563.
  20. ^ Walker BF, French SD, Grant W, Green S (February 2011). "A Cochrane review of combined chiropractic interventions for low-back pain". Spine. 36 (3): 230–242. doi:10.1097/BRS.0b013e318202ac73. PMID 21248591. S2CID 26310171.
  21. ^ Dagenais S, Gay RE, Tricco AC, Freeman MD, Mayer JM (October 2010). "NASS Contemporary Concepts in Spine Care: spinal manipulation therapy for acute low back pain". The Spine Journal. 10 (10): 918–940. doi:10.1016/j.spinee.2010.07.389. PMID 20869008.
  22. ^ Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW (February 2011). Rubinstein SM (ed.). "Spinal manipulative therapy for chronic low-back pain". The Cochrane Database of Systematic Reviews (2): CD008112. doi:10.1002/14651858.CD008112.pub2. hdl:1887/117578. PMID 21328304.
  23. ^ Rubinstein SM, Terwee CB, Assendelft WJ, de Boer MR, van Tulder MW (September 2012). "Spinal manipulative therapy for acute low-back pain". The Cochrane Database of Systematic Reviews. 9 (9): CD008880. doi:10.1002/14651858.CD008880.pub2. hdl:1871/48563. PMC 6885055. PMID 22972127.
  24. ^ a b Ferreira ML, de Luca K, Haile LM, Steinmetz JD, Culbreth GT, Cross M, et al. (GBD 2021 Low Back Pain Collaborators) (June 2023). "Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021". The Lancet. Rheumatology. 5 (6): e316–e329. doi:10.1016/S2665-9913(23)00098-X. PMC 10234592. PMID 37273833.
  25. ^ Vinod Malhotra, Yao, Fun-Sun F., Fontes, Manuel da Costa (2011). Yao and Artusio's Anesthesiology: Problem-Oriented Patient Management. Hagerstwon, MD: Lippincott Williams & Wilkins. pp. Chapter 49. ISBN 978-1-4511-0265-9. Archived from the original on 8 September 2017.

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