Back Pain, Low



  • 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


Annually, 7% in the United States (1)

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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