Back Pain, Low

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Basics

Description

  • Low back pain (LBP) is extremely common and includes a wide range of symptoms involving the lumbosacral spine and pelvic girdle.
  • Characterized by duration or associated symptoms
  • Duration (1)[A]
    • Acute (<6 weeks)
    • Subacute (>6 weeks but <3 months)
    • Chronic (>3 months)
  • Associated symptoms (1)[A]
    • Localized/nonspecific “mechanical” LBP
    • Back pain with lower extremity symptoms
    • Systemic and visceral symptoms
  • A specific cause is not found for most patients with LBP. Most cases resolve in 4 to 6 weeks.
  • Rule out “red” flag symptoms indicating the need for immediate intervention.
  • System(s) affected: musculoskeletal, neurologic
  • Synonym(s): lumbago, lumbar sprain/strain, low back syndrome

Epidemiology

Incidence
  • 1-year incidence for first episode: 6.3–15.3% (2)
  • 1-year incidence for any episode: 1.5%–36% (2)
  • A very common primary care complaint (1)

Prevalence
  • Lifetime prevalence: 84% (1)
  • Global point prevalence: 9% (1)
  • Chronic point prevalence in United States: 13.1%
  • Predominant sex: male = female
  • Age: The highest incidence is in the 3rd decade (20 to 29 years); overall prevalence increases with age until age 65 years and then declines (1).

Etiology and Pathophysiology

LBP can be commonly due to muscle spasm/tension. Estimated 39% of chronic LBP due to disk degeneration. 30% estimated to be from facet joint syndrome. Other possibilities include sacroiliac injuries/degeneration and spinal stenosis. Age-related degenerative changes of the lumbosacral spine and atrophy of supporting musculature may contribute as well (2)[A].

Risk Factors

  • Age (1)[A]
  • Activity (lifting, sudden twisting, bending) (1)[A]
  • Obesity (1)[A]
  • Sedentary lifestyle (1)[A]
  • Physically strenuous work (1)[A]
  • Psychosocial factors—anxiety, depression, stress (1)[A]
  • Genetic factors (2)
  • Heavy operating equipment (2)
  • Poor flexibility (2)
  • Smoking (1)[A]

General Prevention

  • Maintain normal weight (1)[A].
  • Adequate physical fitness and activity (1)[A]
  • Stress reduction (1)[A]
  • Proper lifting technique and good posture
  • Smoking cessation
  • There is insufficient evidence to recommend for or against routine preventive measures in adults.

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