Low back pain – a review
DOI:
https://doi.org/10.12775/QS.2025.38.57930Keywords
Low back pain, pathogenesis, diagnostics, imaging diagnosis, treatment, preventionAbstract
Low back pain (LBP) is a common condition affecting many individuals worldwide. Furthermore, it represents a significant economic challenge for healthcare systems due to its substantial associated costs. The etiology of LBP is complex but, in most cases, is not caused by serious underlying diseases. Physical examination remains the cornerstone of diagnosis, while additional tests, including imaging, are determined based on the clinical context. Treatment involves a combination of non-pharmacological, pharmacological, and invasive interventions. Despite numerous attempts to prevent LBP, only a few methods have been scientifically proven to be effective.
The aim of this review was to provide a comprehensive summary of evidence-based information and approaches regarding the pathogenesis, treatment, and prevention of LBP. The literature reviewed was sourced from PubMed and Google Scholar Rusing the key words "low back pain" combined with terms such as "pathogenesis," "diagnostics," "imaging diagnostics," "treatment," and "prevention."
References
1. Manchikanti, L., Singh, V., Datta, S., Cohen, S. P., Hirsch, J. A., & American Society of Interventional Pain Physicians (2009). Comprehensive review of epidemiology, scope, and impact of spinal pain. Pain physician, 12(4), E35–E70.
2. Casser, H. R., Seddigh, S., & Rauschmann, M. (2016). Acute lumbar back pain. Dtsch Arztebl Int, 113(13), 223–234. https://doi.org/10.3238/arztebl.2016.0223
3. Dieleman, J. L., Cao, J., Chapin, A., et al. (2020). US health care spending by payer and health condition, 1996–2016. JAMA, 323(9), 863–884. https://doi.org/10.1001/jama.2020.0734
4. Buchbinder, R., van Tulder, M., Öberg, B., Costa, L. M., Woolf, A., Schoene, M., Croft, P., & Lancet Low Back Pain Series Working Group. (2018). Low back pain: A call for action. The Lancet, 391(10137), 2384–2388. https://doi.org/10.1016/S0140-6736(18)30488-4
5. Hoy, D., Bain, C., Williams, G., March, L., Brooks, P., Blyth, F., Woolf, A., Vos, T., & Buchbinder, R. (2012). A systematic review of the global prevalence of low back pain. Arthritis & Rheumatism, 64(6), 2028–2037. https://doi.org/10.1002/art.34347
6. Deyo, R. A., & Weinstein, J. N. (2001). Low back pain. New England Journal of Medicine, 344(5), 363–370. https://doi.org/10.1056/nejm200102013440508
7. Tavee, J. O., & Levin, K. H. (2017). Low back pain. Continuum (Minneap. Minn), 23(2, Selected Topics in Outpatient Neurology), 467–486. https://doi.org/10.1212/CON.0000000000000460
8. Koes, B. W., van Tulder, M. W., & Thomas, S. (2006). Diagnosis and treatment of low back pain. BMJ, 332, 1430–1434. https://doi.org/10.1136/bmj.332.7555.1430
9. Kopka, M. (2019). Bóle w dolnym odcinku kręgosłupa – przegląd literatury. Ból, 20(3), 51–59.
10. Maciejczak, A., & Goncerz, G. (2024). Spinal pain syndromes. In Medycyna Praktyczna – Interna. Retrieved January 17, 2025, from https://www.mp.pl/interna/chapter/B16.II.16.43
11. Woroń, J. (2020). Bóle dolnego odcinka kręgosłupa – aktualne zasady leczenia. Neurologia po Dyplomie, 01. Retrieved January 17, 2025, from https://podyplomie.pl/neurologia/33668,bole-dolnego-odcinka-kregoslupa-aktualne-zasady-leczenia
12. Nicol, V., Verdaguer, C., Daste, C., Bisseriex, H., Lapeyre, É., Lefèvre-Colau, M. M., Rannou, F., Rören, A., Facione, J., & Nguyen, C. (2023). Chronic low back pain: A narrative review of recent international guidelines for diagnosis and conservative treatment. Journal of Clinical Medicine, 12(4), 1685. https://doi.org/10.3390/jcm12041685
13. Urits, I., Burshtein, A., Sharma, M., et al. (2019). Low back pain, a comprehensive review: Pathophysiology, diagnosis, and treatment. Current Pain and Headache Reports, 23(23). https://doi.org/10.1007/s11916-019-0757-1
14. Hooten, W. M., & Cohen, S. P. (2015). Evaluation and treatment of low back pain: A clinically focused review for primary care specialists. Mayo Clinic Proceedings, 90(12), 1699–1718. https://doi.org/10.1016/j.mayocp.2015.08.024
15. Laslett, M., McDonald, B., Aprill, C. N., Tropp, H., & Öberg, B. (2006). Clinical predictors of screening lumbar zygapophyseal joint blocks: Development of clinical prediction rules. Spine Journal, 6(4), 370–379. https://doi.org/10.1016/j.spinee.2005.09.015
16. Global Burden of Disease Study 2013 Collaborators. (2015). Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: A systematic analysis for the Global Burden of Disease Study 2013. The Lancet, 386(9995), 743–800. https://doi.org/10.1016/S0140-6736(15)60692-4
17. Chou R. (2014). In the clinic. Low back pain. Annals of internal medicine, 160(11), ITC6–ITC1. https://doi.org/10.7326/0003-4819-160-11-201406030-01006
18. Hill, J. C., Dunn, K. M., Lewis, M., Mullis, R., Main, C. J., Foster, N. E., & Hay, E. M. (2008). A primary care back pain screening tool: identifying patient subgroups for initial treatment. Arthritis and rheumatism, 59(5), 632–641. https://doi.org/10.1002/art.23563
19. Linton, S. J., & Halldén, K. (1998). Can we screen for problematic back pain? A screening questionnaire for predicting outcome in acute and subacute back pain. The Clinical journal of pain, 14(3), 209–215. https://doi.org/10.1097/00002508-199809000-00007
20. Bagwell, J. J., Bauer, L., Gradoz, M., & Grindstaff, T. L. (2016). THE RELIABILITY OF FABER TEST HIP RANGE OF MOTION MEASUREMENTS. International journal of sports physical therapy, 11(7), 1101–1105.
21. Zelle, B. A., Gruen, G. S., Brown, S., & George, S. (2005). Sacroiliac joint dysfunction: evaluation and management. The Clinical journal of pain, 21(5), 446–455. https://doi.org/10.1097/01.ajp.0000131413.07468.8e
22. Kunow, A., Freyer Martins Pereira, J., & Chenot, J. F. (2024). Extravertebral low back pain: A scoping review. BMC Musculoskeletal Disorders, 25(363). https://doi.org/10.1186/s12891-024-07435-9
23. Alves, G. S., Vera, G. E. Z., Maher, C. G., Ferreira, G. E., Machado, G. C., Buchbinder, R., Pinto, R. Z., & Oliveira, C. B. (2024). Clinical care standards for the management of low back pain: A scoping review. Rheumatology International, 44(7), 1197–1207. https://doi.org/10.1007/s00296-024-05543-2
24. Casiano, V. E., Sarwan, G., Dydyk, A. M., & Varacallo, M. A. (2023). Back Pain. In StatPearls. StatPearls Publishing.
25. Miller, R., Beck, N. A., Sampson, N. R., Zhu, X., Flynn, J. M., & Drummond, D. (2013). Imaging modalities for low back pain in children: a review of spondyloysis and undiagnosed mechanical back pain. Journal of pediatric orthopedics, 33(3), 282–288. https://doi.org/10.1097/BPO.0b013e318287fffb
26. Jenkins, H. J., Downie, A. S., Maher, C. G., Moloney, N. A., Magnussen, J. S., & Hancock, M. J. (2018). Imaging for low back pain: Is clinical use consistent with guidelines? A systematic review and meta-analysis. Spine Journal, 18(12), 2266–2277. https://doi.org/10.1016/j.spinee.2018.05.004
27. Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., Halabi, S., Turner, J. A., Avins, A. L., James, K., Wald, J. T., Kallmes, D. F., & Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR American Journal of Neuroradiology, 36(4), 811–816. https://doi.org/10.3174/ajnr.A4173
28. Williams, C. M., Maher, C. G., Latimer, J., McLachlan, A. J., Hancock, M. J., Day, R. O., & Lin, C. W. (2014). Efficacy of paracetamol for acute low-back pain: A double-blind, randomised controlled trial. The Lancet, 384(9954), 1586–1596. https://doi.org/10.1016/S0140-6736(14)60805-9
29. Fritz, J. M., Magel, J. S., McFadden, M., Asche, C., Thackeray, A., Meier, W., & Brennan, G. (2015). Early physical therapy vs usual care in patients with recent-onset low back pain: A randomized clinical trial. JAMA, 314(14), 1459–1467. https://doi.org/10.1001/jama.2015.11648
30. Wong, J. J., Côté, P., Sutton, D. A., Randhawa, K., Yu, H., Varatharajan, S., ... & Taylor‐Vaisey, A. (2017). Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. European Journal of Pain, 21(2), 201–216. https://doi.org/10.1002/ejp.931
31. Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. (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. https://doi.org/10.7326/M16-2367
32. Stochkendahl, M. J., Kjaer, P., Hartvigsen, J., Kongsted, A., Aaboe, J., Andersen, M., ... & Vaagholt, M. (2018). National clinical guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. European Spine Journal, 27, 60–75. https://doi.org/10.1007/s00586-017-5099-2
33. Muehlbacher, M., Nickel, M. K., Kettler, C., Tritt, K., Lahmann, C., Leiberich, P. K., ... & Kaplan, P. (2006). Topiramate in treatment of patients with chronic low back pain: a randomized, double-blind, placebo-controlled study. The Clinical journal of pain, 22(6), 526-531.
34. Hegmann, K. T., Travis, R., Andersson, G. B. J., Belcourt, R. M., Carragee, E. J., Donelson, R., Eskay-Auerbach, M., et al. (2020). Non-invasive and minimally invasive management of low back disorders. Journal of Occupational and Environmental Medicine, 62, e111–e138. https://doi.org/10.1097/JOM.0000000000001812
35. Kreiner, D. S., Matz, P., Bono, C. M., Cho, C. H., Easa, J. E., Ghiselli, G., Ghogawala, Z., et al. (2020). Guideline summary review: An evidence-based clinical guideline for the diagnosis and treatment of low back pain. Spine Journal, 20, 998–1024. https://doi.org/10.1016/j.spinee.2020.04.006
36. Deyo, R. A., & Mirza, S. K. (2016). Herniated lumbar intervertebral disk. New England Journal of Medicine, 374(18), 1763–1772. https://doi.org/10.1056/NEJMra1515560
37. Chou, R., Baisden, J., Carragee, E. J., Resnick, D. K., Shaffer, W. O., & Loeser, J. D. (2009). Surgery for low back pain: A review of the evidence for an American Pain Society clinical practice guideline. Spine, 34(10), 1094–1109. https://doi.org/10.1097/BRS.0b013e3181a105fc
38. Forouzanfar, M. H., Afshin, A., Alexander, L. T., Anderson, H. R., Bhutta, Z. A., Biryukov, S., ... & Carrero, J. J. (2016). Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: A systematic analysis for the Global Burden of Disease Study 2015. The Lancet, 388(10053), 1659–1724. https://doi.org/10.1016/S0140-6736(16)31679-8
39. Steffens, D., Maher, C. G., Pereira, L. S., Stevens, M. L., Oliveira, V. C., Chapple, M., Teixeira-Salmela, L. F., & Hancock, M. J. (2016). Prevention of low back pain: A systematic review and meta-analysis. JAMA Internal Medicine, 176(2), 199–208. https://doi.org/10.1001/jamainternmed.2015.7431
40. Shiri, R., Coggon, D., & Falah-Hassani, K. (2018). Exercise for the prevention of low back pain: Systematic review and meta-analysis of controlled trials. American Journal of Epidemiology, 187(5), 1093–1101. https://doi.org/10.1093/aje/kwx337
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Kacper Rusiński, Filip Klimas, Dorota Zatłoka-Mazur, Michał Sienkiewicz, Bartosz Pawłowski, Adriana Potoczek , Zuzanna Zięba, Iwona Pudełko , Zuzanna Gajda
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 29
Number of citations: 0
