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 countries1 2. 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 population5.
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 therapies3 5. Factors such as physically demanding jobs, physical and mental comorbidities, smoking, and obesity increase the risk of developing low back pain1.
Specific Pathological Causes
A small proportion of low back pain cases can be attributed to specific pathological conditions such as vertebral fractures, malignancies, or infections1. In young athletes, structural injuries like spondylolysis are common causes of low back pain, often resulting from sports involving repetitive extension, flexion, and rotation9.
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 pain1 2. Social factors, including low socioeconomic status, are associated with a higher prevalence of disabling low back pain1.
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 interventions2 8.
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 necessary4. Self-management with appropriate support is generally recommended, and the overuse of imaging, opioids, and surgery should be avoided3 5.
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 consequences2 7. Recent research has improved the understanding of the genetic and brain mechanisms underlying low back pain, providing new insights for diagnosis and treatment8.
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.
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Most relevant research papers on this topic
What low back pain is and why we need to pay attention
Low back pain is a common and leading cause of disability worldwide, with increasing disability and costs in low-income and middle-income countries.
Rigorous Journal
Highly CitedLow back pain
Low back pain management requires a multidisciplinary approach integrating biological, psychological, and social aspects, with progress in understanding psychological, social risk factors, genetics, and brain mechanisms.
Highly CitedNon-specific low back pain
Non-specific low back pain can be effectively managed through education, reassurance, analgesic medicines, non-pharmacological therapies, and timely review, with overuse of imaging, opioids, and surgery being a widespread issue.
Rigorous JournalHighly CitedLow Back Pain
Low back pain is often managed with nonpharmacologic therapies, such as exercise and psychosocial management, and may require surgery for severe cases.
Rigorous JournalNon-specific low back pain
Non-specific low back pain is a major public health issue, with genetic constitution playing a significant role in its pathogenesis, and self-management with appropriate support is recommended for effective pain management.
Rigorous JournalHighly CitedLow back pain: a call for action
Low back pain is the leading cause of disability worldwide, with its burden growing alongside the aging population and is unrelated to specific spinal abnormalities.
Rigorous JournalHighly CitedDiagnosis and treatment of low back pain
Evidence-based management of low back pain has greatly improved, with improved diagnostic and treatment methods.
Systematic ReviewRigorous JournalHighly CitedLow back pain.
Advances in understanding low back pain have led to the development of new diagnostic procedures, evidence-based screening methods, and targeted interventions, emphasizing the need for a multidisciplinary approach integrating biological, psychological, and social aspects.
Highly CitedLow Back Pain in Young Athletes
Young athletes with low back pain are more likely to have structural injuries, and treatment should focus on flexibility and muscle imbalances to prevent future injuries.
Systematic ReviewHighly CitedMechanisms of low back pain: a guide for diagnosis and therapy
This paper provides a guide for clinicians to identify specific pain generators in chronic low back pain, aiding in safer and faster diagnosis and therapeutic management.
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