Low back pain (LBP) is the leading cause of disability burden worldwide. This article outlines how health professionals can reach a diagnosis of nonspecific LBP and reviews the recommended nonpharmacological and pharmacological treatments with reference to the UK, US and Denmark clinical practice guidelines, as well as the Lancet Low Back Pain series.
- Detailed history taking and a physical examination are recommended to triage patients with low back pain (LBP) into: those with LBP caused by nonspinal causes; those with serious spinal pathology; those with radicular syndromes; and those with nonspecific LBP (NSLBP).
- Diagnostic imaging and other investigations are only required for the small number of patients with suspected serious or specific pathology.
- Most patients with LBP including radicular syndromes do not require immediate diagnostic imaging and can be managed in primary care.
- All patients presenting with NSLBP should be asked about their beliefs and their expectations from the consultation, offered information on the non-life- threatening but recurrent nature of LBP and advice on self-management.
- For patients with acute NSLBP who do not respond to education and self-care advice, and are slow to recover, consider nonpharmacological treatments for pain relief such as heat and exercise.
- For patients with persistent NSLBP, consider nonpharmacological treatments for pain relief, such as exercise programs, psychological treatments, spinal manipulation, massage and interdisciplinary rehabilitation.
- Pharmacological treatment is best avoided as many commonly used therapies have been proven ineffective or harmful; however, NSAIDs may provide short-term limited benefits.