Chronic Low Back Pain: A Narrative Review of Recent International Guidelines for Diagnosis and Conservative Treatment

Abstract

Chronic low back pain (cLBP) is a public and occupational health problem that is a major professional, economic and social burden. We aimed to provide a critical overview of current international recommendations regarding the management of non-specific cLBP. We conducted a narrative review of international guidelines for the diagnosis and conservative treatment of people with non-specific cLBP. Our literature search yielded five reviews of guidelines published between 2018 and 2021. In these five reviews, we identified eight international guidelines that fulfilled our selection criteria. We added the 2021 French guidelines into our analysis. Regarding diagnosis, most international guidelines recommend searching for so-called yellow, blue and black flags, in order to stratify the risk of chronicity and/or persistent disability. The relevance of clinical examination and imaging are under debate. Regarding management, most international guidelines recommend non-pharmacological treatments, including exercise therapy, physical activity, physiotherapy and education; however, multidisciplinary rehabilitation, in selected cases, is the core treatment recommended for people with non-specific cLBP. Oral, topical or injected pharmacological treatments are under debate, and may be offered to selected and well-phenotyped patients. The diagnosis of people with cLBP may lack precision. All guidelines recommend multimodal management. In clinical practice, the management of individuals with non-specific cLBP should combine non-pharmacological and pharmacological treatments. Future research should focus on improving tailorization.

Exercise interventions for nonspecific low back pain: a bibliometric analysis of global research from 2018 to 2023

“…The lifetime prevalence of LBP is between 70 and 80%, with a significant portion of patients (10 to 20%) developing chronic LBP lasting at least 3 months ( 7 ). Although traditional medical approaches like medication and surgery play a crucial role in treating LBP, they often come with potential side effects and high costs ( 8 ). In light of this, exercise therapy, as a non-pharmacological intervention, is increasingly favored by physicians and patients alike, owing to its minimal side effects, low cost, and ease of implementation.…”

Epidemiology of low back pain: frequency, risk factors, and patterns in South-South Nigeria

“…Low back pain (LBP) is a major public health concern globally transcending ages, occupations, and socioeconomic backgrounds [ 1 ]. It is a prevalent musculoskeletal problem, with up to 84% of adults experiencing it at least once in their lives [ 1 ].…”

“…Low back pain (LBP) is a major public health concern globally transcending ages, occupations, and socioeconomic backgrounds [ 1 ]. It is a prevalent musculoskeletal problem, with up to 84% of adults experiencing it at least once in their lives [ 1 ]. Low back pain has become a primary cause of disability and work absenteeism worldwide, leading to significant economic challenges and reduced productivity [ 2 ].…”

“…The most effective strategy involves a multidisciplinary and multimodal approach, offering comprehensive therapy to alleviate pain, enhance function, and address pain-generating mechanisms to reduce the likelihood of recurrence [ 1 , 11 ].…”

The Effects of Combined Motor Control and Isolated Extensor Strengthening versus General Exercise on Paraspinal Muscle Morphology, Composition, and Function in Patients with Chronic Low Back Pain: A Randomized Controlled Trial

“…A significant percentage of people with chronic LBP seek physical therapy care to alleviate their pain and improve their functional capacity [ 17 , 18 ]. Physical therapy plays a central and pivotal role within an integrated multidisciplinary treatment strategy for chronic LBP, synergizing with instrumental therapies, medications, and injections, as highlighted in previous studies [ 19 , 20 , 21 ]. The cohesive approach of LBP management highlights the significance of physical therapy interventions in addressing both the physical and psychosocial dimensions of the condition.…”