An overview of conservative treatment for lower back pain

Abstract

Low back pain (LBP) remains the most frequent musculoskeletal complaint worldwide and all age groups are affected by these symptoms. They are classically stratified into acute, subacute and chronic, with respective cut-offs of <6 weeks, 6-12 weeks and >12 weeks [1].By itself, it produces direct and indirect costs of hundreds of billions of dollars for the US alone. Recent studies in adults and elderly populations have shown a significant increase in LBP, both in numbers and costs, in terms of investigations, treatments and disability, an observation at least partially explained by a raise in prevalence [2,101]. However, the large differences in the rate of spinal surgical procedures observed between states within the US [3], as well as between countries worldwide, suggest that decision-making is certainly influenced by regulations and other sociopolitical factors.As LBP is extremely prevalent, the main problem remains the chronic cases, in particular in term of investigations and costs. Acute episodes of LBP statistically have quite a good prognosis more or less independently of the chosen treatment. A recent review confirms that a variety of treatments of acute LBP are effective and supported by the literature [4]. Moreover, there are excellent updated reviews on the management of acute pain not limited to but including LBP [5]. The interested reader can download this electronically [102].If until recently a figure of 8-10% was usually accepted as the number of acute LBP episodes evolving into chronic cases, recent studies have show much more ominous figures with frequent relapses and persistence of symptoms at 1 year in up to 10-30% of cases according to definitions used. On the other hand, more than a third of the patients with LBP for more than 3 months do recover within 12 months [6][7][8][9].Defining if a patient is going to become chronic or establishing an individual prognosis based on epidemiological studies is a very difficult task. Certainly, a precise diagnosis would help. However, it is commonly accepted that a specific identifiable etiology is only found in around 15% of cases, including disk herniations, spinal stenosis, osteoporotic fractures, inflammatory diseases and the infrequent (approximately 1%) specific neoplastic or infectious destructive lesions [10]. The largest part of this manuscript is devoted to the 85% of patients asking for medical attention and suffering from chronic LBP without any of those specific identifiable etiologies, the so-called nonspecific (NS) LBP. Furthermore, we included spinal stenosis and lumbar disc herniation in the discussion in regard to their frequency in daily practice.It has been shown already in adolescent populations that psychosocial factors are stronger predictors of incident LBP than mechanical factors [11]. In adult populations, psychosocial factors are risk factors for chronicity much more strongly related to outcome than any clinical or mechanical variables [12,13], while previous episodes of pain are strong predictors of future ones. Twin's cohort ...

Triage for Patients with Spinal Complaints: A Systematic Review of the Literature

“…In this way, only those patients who do not respond to conservative management options would remain on track to consult a medical specialist. This would have the outcome of ensuring that patients who need to progress to surgery do so without unnecessary delay and those for whom surgery is not a realistic option could be provided with alternative non‐surgical care, also without delay (Martin et al ., ; Balagué and Dudler, ).…”

Fear avoidance beliefs as a predictor for long-term sick leave, disability and pain in patients with chronic low back pain

“…low back pain (LBP) for at least 3 months [ 1 ]. Despite the large amount of research conducted in the field of CLBP, the treatment effect is moderate at its best [ 2 , 3 ]. The heterogeneity of patients with CLBP indicates that it might be beneficial to classify the patients into subgroups prior to selecting treatment strategy, as subgroups with various characteristics respond differently to the same treatment [ 4 ].…”

The management of acute low back pain in adults: a guide for the primary care physician, Part II

“…Simple LBP constitutes 90% of chronic back pain that is seen in general practice, serious spinal pathology (8%) and nerve root compromise (2%). 11,13 …”