Low Back Pain: Clinical Treatment and Management

Dear Colleagues,

Low back pain (LBP) is defined by the World Health Organization as “pain inferior to the lowest costal margin and superior to the inferior gluteal folds with or without referred leg pain”.

Low back pain (LBP) is one of the most common musculoskeletal conditions globally, affecting up to 84% of people in their lifetime and not only affecting individuals’ daily lives but also imposing a heavy social burden and economic cost, representing a significant challenge to healthcare systems. The diagnosis of LBP is difficult due to the multifactorial etiology and varying presentation. Patients suffering from LBP are generally classified based on the duration, cause, characteristics, and episodic nature of their symptoms. The prevalence of a serious spinal disease in patients presenting with acute low back pain to the general practitioner’s office is <1%.

Improving diagnostic accuracy for LBP remains a critical area of research. In the majority of cases presenting with acute low back pain, a specific underlying cause explaining the pain cannot be identified; thus, it is non-specific. Studies showed that early MRI in acute low back pain did not result in improved outcomes or better management.

The main reason against recommending early imaging is that studies showed no impact on low back pain management and outcome and potential unintended consequences such as overdiagnosis and over-treatment with higher healthcare utilization, poor patient well-being and delayed return to work. Further inadequate and ineffective management may increase the risk of chronic low back pain. There are many different treatments for chronic LBP with varying degrees of evidence. 

To standardize the management of LBP, various institutions have developed an increasing number of clinical practice guidelines, providing recommendations for diagnosis and management.

Most clinical practice guidelines recommend physical activity, such as staying active, cognitive behavioral therapy, transcutaneous electrical nerve stimulation (TENS), topical nonsteroidal anti‐inflammatory, low-level laser therapy, spinal manipulation, and nonsteroidal anti-inflammatory drugs.

Pharmacological interventions are the most common interventions used by people with LBP to manage their pain.

Advances in LBP rehabilitation and treatment hold great potential to progress the field of rehabilitation sciences by identifying novel techniques and methodologies to reduce errors, eliminate medical referrals, and accurately predict consequential health outcomes.

Dr. Raffaello Pellegrino
Dr. Angelo Di Iorio
Guest Editors

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