Non-Specific Low Back Pain

Chenot, Jean‐François; Greitemann, Bernhard; Kladny, Bernd; Petzke, Frank; Pfingsten, M.; Schorr, Susanne Gabriele

doi:10.3238/arztebl.2017.0883

Cited by 186 publications

(255 citation statements)

References 132 publications

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“…Six guidelines [1,7,11,20,26,28] (40%) provided recommendations for patients with acute, subacute, and chronic LBP (i.e., Canada, Finland, Mexico, Philippine, Spain, and the USA), two guidelines [15,31] (13%) focussed on acute and chronic LBP (i.e., Malaysia and the Netherlands), three guidelines [9,25,30] (20%) focussed on acute LBP (i.e., Australia, and Denmark), and one guideline [3] (7%) focussed on chronic LBP (i.e., Brazil). In addition, three guidelines [10,24,32] (20%) provided recommendations regardless of the duration of symptoms (i.e., Africa, Belgium, Germany and the UK). Therefore, ten guidelines contained recommendations for patients with acute LBP, six guidelines contained recommendations for patients with subacute LBP, and nine guidelines contained recommendations for patients with chronic LBP.…”

Section: Resultsmentioning

confidence: 99%

“…Box 2 provides these yellow flags endorsed by most clinical practice guidelines. Four guidelines [10,24,25,32] (33%) recommend assessment using validated prognostic screening tools (e.g., STarT Back and Orebro) which combine a number of yellow flags. The Danish guideline [30] recommends against targeted treatment for a subgroup of patients with specific prognostic factors.…”

Section: Diagnostic Recommendationsmentioning

confidence: 99%

“…The Danish guideline [30] recommends against targeted treatment for a subgroup of patients with specific prognostic factors. Regarding the optimal timing to assess yellow flags, most guidelines [7,10,11,15,24,25, 32] (7 out of 12; 58%) recommend assessment during the first or second consultation.…”

Section: Diagnostic Recommendationsmentioning

confidence: 99%

“…Recommendations on reassurance or advice for patients with non-specific LBP were identified in 14 guidelines. Most guidelines (7 out of 12; 58%) recommend advice to maintain normal activities for patients with acute LBP [1, 7,10,15,25,30,32], and some guidelines (42%) recommend the same advice for patients with any duration of symptoms [20,24,26,31,32]. In addition, most guidelines (10 out of 14; 71%) recommend reassuring the patient that LBP is not a serious illness regardless of the duration of symptoms or reassuring patients with acute LBP of the favorable prognosis [7, 15, 20, 24-26, 28, 30-32].…”

Section: Treatment Recommendationsmentioning

confidence: 99%

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Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview

et al. 2018

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We identified 15 clinical practice guidelines for the management of low back pain in primary care. For diagnosis of patients with non-specific low back pain, the clinical practice guidelines recommend history taking and physical examination to identify red flags, neurological testing to identify radicular syndrome, use of imaging if serious pathology is suspected (but discourage routine use), and assessment of psychosocial factors. For treatment of patients with acute low back pain, the guidelines recommend reassurance on the favourable prognosis and advice on returning to normal activities, avoiding bed rest, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and weak opioids for short periods. For treatment of patients with chronic low back pain, the guidelines recommend the use of NSAIDs and antidepressants, exercise therapy, and psychosocial interventions. In addition, referral to a specialist is recommended in case of suspicion of specific pathologies or radiculopathy or if there is no improvement after 4 weeks. While there were a few discrepancies across the current clinical practice guidelines, a substantial proportion of recommendations was consistently endorsed. In the current review, we identified some differences compared to the previous overview regarding the recommendations for assessment of psychosocial factors, the use of some medications (e.g., paracetamol) as well as an increasing amount of information regarding the types of exercise, mode of delivery, acupuncture, herbal medicines, and invasive treatments. These slides can be retrieved under Electronic Supplementary Material.

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Section: Resultsmentioning

confidence: 99%

Section: Diagnostic Recommendationsmentioning

confidence: 99%

Section: Diagnostic Recommendationsmentioning

confidence: 99%

Section: Treatment Recommendationsmentioning

confidence: 99%

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Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview

et al. 2018

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“…This may reflect a lack of attention among healthcare providers to existing clinical guidelines (Oppong‐Yeboah & May ). The most current clinical guidelines reflect that there is a clear movement away from medicalised to non‐medicalised management of LBP (Chenot et al, ; Qaseem, Wilt, McLean, & Forciea, ; Stochkendahl et al, ). In principle, healthcare providers following these guidelines need to manage uncomplicated cases of LBP with advice, education and reassurance.…”

Section: Discussionmentioning

confidence: 99%

Determinants of healthcare utilisation for low back pain: A population‐based study in Ethiopia

Beyera

O’Brien

Campbell

2020

Health Soc Care Community

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Low back pain (LBP) remains one of the major public health problems worldwide. However, in low‐income countries, such as those in Africa, the epidemiological data on healthcare utilisation for LBP are lacking due to more pressing problems such as infectious diseases, to which the majority of health resources are channelled. Therefore, this study aimed at investigating the determinants of healthcare utilisation for LBP in the general population of Ethiopia. A population‐based cross‐sectional study was conducted in South‐West Shewa zone of Ethiopia from June to November 2018. The data were collected by interviewing adults with LBP (n = 1812, randomly selected) using a psychometrically tested and validated instrument, analysed using R version 3.5.1. A log‐binomial regression model was used to determine the prevalence ratio with a 95% confidence interval (CI) in identifying factors associated with healthcare utilisation for LBP. Estimates of population parameters were also presented with 95% CIs and p values. For all applications of inferential statistics, a p value of ≤.05 was taken as the significance level. The lifetime prevalence of healthcare utilisation for LBP was 36.1%, 95% CI: 33.9–38.1, while the annual prevalence rate was 30%, 95% CI: 27.9–32.2. Of those with a 1‐year history of healthcare utilisation, while 7.4%, 95% CI: 4.9–10.3 rural and 36.6%, 95% CI: 29.5–44 urban populations utilised healthcare from general hospitals, 1.4%, 95% CI: 0.3–2.7 rural and 6.8%, 95% CI: 3.1–10.8 urban populations utilised healthcare from specialised hospitals. Several sociodemographic factors, modifiable health behaviours/lifestyle habits, pain interrelated factors, and specific factors such as beliefs about the pain, depressive symptoms and insomnia were associated with healthcare utilisation for LBP. The implications of this research are that it may be prudent for the Ethiopian healthcare policy makers to develop the necessary strategies to meet the health needs of both urban and rural populations with LBP.

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Opioids for chronic low back pain: An updated systematic review and meta‐analysis of efficacy, tolerability and safety in randomized placebo‐controlled studies of at least 4 weeks of double‐blind duration

Petzke

Klose

Welsch

et al. 2019

European Journal of Pain

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Background and Objective This updated systematic review evaluated the efficacy, tolerability and safety of opioids compared to placebo in non‐malignant chronic low back pain. Databases and Data Treatment Clinicaltrials.gov, CENTRAL, MEDLINE and PsycINFO were searched from October 2013 to May 2019. Randomized controlled trials comparing opioids with placebo and at least 4 weeks of double‐blinded duration were analysed. Primary outcomes were pain relief of 50% or greater, disability, tolerability and safety. Effects were summarized by a random effects model using risk differences or standardized mean differences. We added nine new studies with 2,980 participants for a total of 21 studies with 7,650 participants. Study duration ranged between 4 and 15 weeks. Studies with a parallel and cross‐over design: Based on very low to low‐quality evidence, opioids provided no clinically relevant pain relief of 50% or greater, but a clinically relevant reduction of disability compared to placebo. Enriched enrolment randomized withdrawal (EERW) design: Based on very low to low‐quality evidence, opioids provided a clinically relevant pain relief of 50% or greater, but not a clinically relevant reduction of disability compared to placebo. There was no clinically relevant harm with regard to serious adverse events by opioids compared to placebo in studies with parallel/cross‐over and EERW design. There was a relevant harm with regard to drop out rates due to adverse events in studies with parallel/cross‐over, but not in studies with EERW design. Conclusions Opioids may provide a safe and clinically relevant pain relief for 4–15 weeks in highly selected patients. Significance Within the context of randomized controlled trials of 4–15 weeks, opioids provided a clinically relevant pain relief of 30% or greater and a clinically relevant reduction of disability compared to placebo in non‐malignant chronic low back pain. Number needed to treat for an additional drop out due to side effects was 11 (95% confidence interval: 6–33). Assessment of abuse and addiction was incomplete. The frequency of serious adverse events including deaths did not differ from placebo.

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Non-Specific Low Back Pain

Abstract: A physician should be in charge of the overall care process. The patient should be kept well informed over the entire course of his or her illness and should be encouraged to adopt a healthful lifestyle, including regular physical exercise.

Cited by 186 publications

References 132 publications

Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview

Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview

Determinants of healthcare utilisation for low back pain: A population‐based study in Ethiopia

Opioids for chronic low back pain: An updated systematic review and meta‐analysis of efficacy, tolerability and safety in randomized placebo‐controlled studies of at least 4 weeks of double‐blind duration

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