Low back pain

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Understanding Low Back Pain: Causes, Risk Factors, and Management

Prevalence and Global Impact of Low Back Pain

Low back pain is a pervasive health issue affecting individuals across all age groups and socioeconomic statuses worldwide. It is the leading cause of disability globally, with a significant increase in years lived with disability attributed to low back pain from 1990 to 2015, particularly in low- and middle-income countries . The lifetime prevalence of low back pain is reported to be as high as 84%, with chronic low back pain affecting about 23% of the population.

Risk Factors and Causes of Low Back Pain

Non-Specific Low Back Pain

Most cases of low back pain are classified as non-specific low back pain, meaning they lack a clear pathoanatomical cause. This type of pain is often managed through education, reassurance, and non-pharmacological therapies . Factors such as physically demanding jobs, physical and mental comorbidities, smoking, and obesity increase the risk of developing low back pain.

Specific Pathological Causes

A small proportion of low back pain cases can be attributed to specific pathological conditions such as vertebral fractures, malignancies, or infections. In young athletes, structural injuries like spondylolysis are common causes of low back pain, often resulting from sports involving repetitive extension, flexion, and rotation.

Psychological and Social Factors

Psychological distress, high initial pain intensity, and pain at multiple body sites are significant predictors of persistent disabling low back pain. Central pain-modulating mechanisms and pain cognitions also play crucial roles in the development of chronic low back pain . Social factors, including low socioeconomic status, are associated with a higher prevalence of disabling low back pain.

Management and Treatment Approaches

Multidisciplinary Approach

Effective management of low back pain requires a multidisciplinary approach that integrates biological, psychological, and social aspects. This approach has led to the development of new diagnostic procedures, evidence-based screening methods, and more targeted interventions .

Non-Pharmacological Therapies

Non-pharmacological therapies, including exercise and psychosocial management, are preferred for most patients with low back pain. These therapies may be supplemented with adjunctive drug treatments when necessary. Self-management with appropriate support is generally recommended, and the overuse of imaging, opioids, and surgery should be avoided .

Diagnostic and Therapeutic Challenges

The diagnostic process for low back pain often involves triage to identify cases requiring specialist referral or diagnostic work-up. Despite advancements, the management of low back pain remains challenging due to the variation in its manifestations, causes, and consequences . Recent research has improved the understanding of the genetic and brain mechanisms underlying low back pain, providing new insights for diagnosis and treatment.

Conclusion

Low back pain is a complex and widespread health issue with significant implications for individuals and healthcare systems worldwide. Addressing this burden requires a comprehensive approach that considers the multifaceted nature of low back pain, including its biological, psychological, and social dimensions. Continued research and global initiatives are essential to develop more effective management strategies and reduce the disability and costs associated with low back pain.