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 (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

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.