Back Pain, Low

Description

• Low back pain (LBP) is a common chief complaint presenting to primary care and acute care settings.
  • 2.5 million were diagnosed with LBP in the United States between 2008 and 2015 (1).
  • Annual expenditure in the United States on LBP care >$100 billion dollars (1)
• Defined as a pain between the costal margins and the inferior gluteal folds (2)
• Suggested classification is by duration (2):
  • Acute: Most cases resolve in 4 to 6 weeks.
  • Recurrent: repetitive occurrence of symptoms in a year
  • Chronic: at least 3 months in duration
• LBP has significant implications on work-life balance.
  • LBP is the leading cause of loss of productivity worldwide (1).
  • LBP is the leading cause of years lived with disability across 126 countries (1).
• It is necessary to 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
Annually, 7% in the United States (1)

Prevalence
Prevalence increases with age (2):

• 1–6% in children 7 to 10 years old
• 18% in adolescents
• 28–42% in ages 40 to 69 years (peak prevalence by age)

Etiology and Pathophysiology

Recent subcategorization by primary type of pain (1):

• Mechanical, including facet arthropathy, myofascial pain, sacroiliac joint dysfunction
• Inflammatory, including spondyloarthropathies
• Neuropathic/radicular (16–55% of chronic LBP)—classical symptoms radiating down legs in dermatomes (1)
  • Herniated disc is a common cause.
  • Spinal stenosis results from age-related degeneration.
  • Less common causes to consider: metastatic disease, herpes zoster
• Nociplastic—amplified pain from central nervous system (1)

Risk Factors

• Age
• High-risk activity (lifting, sudden twisting, bending)
• Obesity
• Sedentary lifestyle
• Physically strenuous work
• Psychosocial factors—anxiety, depression, stress
• Poor flexibility
• Smoking

General Prevention

There is no strong existing evidence for prevention; however, routine physical activity has been shown to be beneficial.