Personalized assessment and management of non‐specific low back pain

Abstract

Background and ObjectiveLow back pain (LBP), and in particular non‐specific low back pain (NSLBP), which accounts for approximately 90% of LBP, is the leading cause of years lived with disability worldwide. In clinical trials, LBP is often poorly categorized into ‘specific’ versus ‘non‐specific’ and ‘acute’ versus ‘chronic’ pain. However, a better understanding of the underlying pain mechanisms might improve study results and reduce the number of NSLBP patients.Databases and Data TreatmentNarrative review.ResultsNSLBP is a multi‐dimensional, biopsychosocial condition that requires all contributing dimensions to be assessed and prioritized. Thereby, the assessment of the contribution of nociceptive, neuropathic and nociplastic pain mechanisms forms the basis for personalized management. In addition, psychosocial (e.g. anxiety, catastrophizing) and contextual factors (e.g. work situation) as well as comorbidities need to be assessed and individually weighted. Personalized treatment of NSLBP further requires individually choosing treatment modalities, for example, exercising, patient education, cognitive‐behavioural advice, pharmacotherapy, as well as tailoring treatment within these modalities, for example, the delivery of tailored psychological interventions or exercise programs. As the main pain mechanism and psychosocial factors may vary over time, re‐assessment is necessary and treatment success should ideally be assessed quantitatively and qualitatively.ConclusionsThe identification of the main contributing pain mechanism and the integration of the patients' view on their condition, including beliefs, preferences, concerns and expectations, are key in the personalized clinical management of NSLBP. In research, particular importance should be placed on accurate characterization of patients and on including outcomes relevant to the individual patient.Significance StatementHere, a comprehensive review of the challenges associated with the diagnostic label ‘non‐specific low back pain’ is given. It outlines what is lacking in current treatment guidelines and it is summarized what is currently known with respect to individual phenotyping. It becomes clear that more research on clinically meaningful subgroups is needed to best tailor treatment approaches.

On-Site Physiotherapy in Emergency Department Patients Presenting with Nonspecific Low Back Pain: A Randomized Controlled Trial

“…The median age of participants was 40 years (IQR, 32-52) and 40.7% of the 86 patients were female. The median body mass index (BMI) was 25 (IQR, [23][24][25][26][27][28][29], the median physical activity vital sign was 150 min per week (IQR, 5.5-300) and 69.8% of the 86 participants took pain medication recently before the initial consultation. No participant was triaged to ESI level 1, 11 (12.8%) patients to ESI level 2, 28 (32.6%) to ESI level 3, 45 (52.3%) to ESI level 4 and 1 (1.2%) to ESI level 5.…”

“…The intervention was conducted face-to-face at the bedside in an ED examination room and took an average of 19 min. The selection of the intervention is based on the scientific evidence indicating that patient education, behavioral instructions and active movement exercises taught by a professional are beneficial for patients with LBP [ 24 , 25 , 26 , 27 , 28 , 29 ].…”

Barriers to using physical exercise as an intervention within inpatient mental health settings: A systematic review

“…Future research is needed to identify practical measures that can be used within clinical practice. Moreover, if PE is introduced into a service user's care plan in accordance with an evidenced-based approach it would minimise the potential of iatrogenic harm (Wirth & Schweinhardt, 2023). This could ensure that PE is offered within treatment plans in a safe and effective way and programmes are offered in a unique fashion based on the individual's physical health needs.…”