What is the backend (etiology) for lower back pain?

From the Guidelines

For patients with back pain, I strongly recommend starting with conservative measures, including non-prescription pain relievers like ibuprofen or naproxen, ice and heat therapy, gentle movement, and gentle stretches, as these approaches have been shown to be effective in reducing inflammation, relaxing muscle tension, and maintaining mobility, according to the most recent and highest quality study 1. When managing back pain, it is essential to conduct a focused history and physical examination to help place patients into one of three broad categories: nonspecific low back pain, back pain potentially associated with radiculopathy or spinal stenosis, or back pain potentially associated with another specific spinal cause, as recommended by the American College of Physicians and the American Pain Society 1. Some key points to consider when managing back pain include:

• Assessing psychosocial risk factors, which predict risk for chronic disabling back pain 1
• Avoiding routine imaging or other diagnostic tests in patients with nonspecific low back pain, unless severe or progressive neurologic deficits are present or when serious underlying conditions are suspected 1
• Considering the use of medications with proven benefits, such as acetaminophen or nonsteroidal anti-inflammatory drugs, in conjunction with back care information and self-care 1
• Evaluating patients with persistent low back pain and signs or symptoms of radiculopathy or spinal stenosis with magnetic resonance imaging (preferred) or computed tomography only if they are potential candidates for surgery or epidural steroid injection 1
• Providing patients with evidence-based information on low back pain, advising them to remain active, and providing information about effective self-care options 1 It is also important to note that the duration of symptoms can help guide treatment algorithms in back pain, with acute low back pain defined as 0 to 4 weeks, subacute LBP defined as 4 to 12 weeks, and chronic LBP defined as >12 weeks 1. In summary, a conservative approach to managing back pain, including the use of non-prescription pain relievers, ice and heat therapy, gentle movement, and gentle stretches, is the most effective way to reduce inflammation, relax muscle tension, and maintain mobility, while also addressing the underlying muscle tension and inflammation, as supported by the most recent and highest quality study 1.

From the Research

Backend for Back Pain

• The management of back pain typically involves a biopsychosocial approach, which provides the best clinical framework 2.
• Conventional therapies, including lifestyle modifications, nonsteroidal anti-inflammatory drugs, physical therapy, and cognitive behavioral therapy, are usually the first line of treatment for back pain 2, 3.
• If these options have been exhausted and pain persists for greater than 6 weeks, imaging and a specialist referral may be indicated 2.
• Conservative management of low back pain includes patient education, therapeutic exercises, and bracing, with a focus on recognizing prognostic factors and initial approaches to evaluation, including selective imaging 3.
• The importance of using appropriate conservative care in the management of low back pain has been increasingly stressed in recent years, as a means of controlling health care costs and instituting patient-centered systems of care 4.

Medications for Back Pain

• Medications such as paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), opioid analgesics, muscle relaxants, antibiotics, and antidepressants may be used to manage back pain, but their effectiveness and safety vary 5.
• For acute low back pain, muscle relaxants and NSAIDs may be superior to placebo for reducing pain, while paracetamol provides no additional benefit 5.
• For chronic low back pain, NSAIDs, antidepressants, and opioids may be superior to placebo for reducing pain, but opioids have an established profile of harms 5.

Prevention and Treatment

• Many clinical practice guidelines recommend similar approaches for the assessment and management of low back pain, including the use of a biopsychosocial framework and initial non-pharmacological treatment 6.
• Recommendations include education that supports self-management and resumption of normal activities and exercise, and psychological programmes for those with persistent symptoms 6.
• Globally, gaps between evidence and practice exist, with limited use of recommended first-line treatments and inappropriately high use of imaging, rest, opioids, spinal injections, and surgery 6.