Back Pain, Low
Basics
Description
- Low back pain (LBP) is a common chief complaint presenting to primary care and acute care settings.
- 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.
- 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.
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Citation
Domino, Frank J., et al., editors. "Back Pain, Low." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117570/0/Back_Pain_Low.
Back Pain, Low. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117570/0/Back_Pain_Low. Accessed December 12, 2024.
Back Pain, Low. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117570/0/Back_Pain_Low
Back Pain, Low [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 December 12]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117570/0/Back_Pain_Low.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Back Pain, Low
ID - 117570
ED - Domino,Frank J,
ED - Baldor,Robert A,
ED - Golding,Jeremy,
ED - Stephens,Mark B,
BT - 5-Minute Clinical Consult, Updating
UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117570/0/Back_Pain_Low
PB - Wolters Kluwer
ET - 33
DB - Medicine Central
DP - Unbound Medicine
ER -