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Cited by 694Musculoskeletal pain and rehabilitationSpine and Intervertebral Disc PathologyPregnancy-related medical research

Low back pain (non-specific)

Krismer, M., van Tulder, M.·2007·Best Practice & Research Clinical Rheumatology
DOI 10.1016/j.berh.2006.08.004
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Abstract

Low back pain (LBP) is defined as pain localised between the 12th rib and the inferior gluteal folds, with or without leg pain. Most cases are non-specific, but in about 10% of cases a specific cause is identified. Red flags are typical signs or symptoms that are frequently associated with specific LBP. Yellow flags are prognostic factors associated with a more unfavourable and often chronic disabling course of the disease. LBP has a lifetime prevalence of 60-85%. At any one time, about 15% of adults have LBP. LBP poses an economic burden to society, mainly in terms of the large number of work days lost (indirect costs) and less so by direct treatment costs. A substantial proportion of individuals with chronic LBP has been found to have chronic widespread pain. LBP is often associated with other pain manifestations such as headache, abdominal pain and pain in different locations of the extremities. Widespread pain is associated with a worse prognosis compared to localised LBP. Treatment targets are reduction of pain and better activity/participation, including prevention of disability as well as maintainance of work capacity. The evidence from selected and appraised guidelines, systematic reviews and major clinical studies was classified into four levels, level Ia being the best level with evidence from meta-analysis of randomised controlled trials. Key recommendations (level Ia): fitness programmes and advice to stay active can reduce pain, improve function and can prevent LBP becoming chronic. Simple analgesics, NSAIDs and muscle relaxants can reduce pain and can improve and maintain function. Maintaining physical activity, avoiding rest and manual therapy can reduce pain and maintain and restore function in acute LBP. Behavioural treatment can prevent LBP becoming chronic. Aerobic fitness and endurance training, behavioural treatment and multi-disciplinary treatment programmes can reduce pain and can improve/maintain function in chronic LBP.

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Authors
Krismer, M., & van Tulder, M.
Affiliations
Innsbruck Medical University (AT)
Venue
Best Practice & Research Clinical Rheumatology
Publisher
Elsevier BV
Published
2007-02
Volume
21
Issue
1
Pages
77-91
ISSN
1521-6942 (ISSN-L)
DOI
10.1016/j.berh.2006.08.004
OpenAlex
W2132397892
Cited by
694
References
42
Citations by year
2026: 18 · 2025: 27 · 2024: 40 · 2023: 32 · 2022: 42 · 2021: 51 · 2020: 36 · 2019: 53 · 2018: 50 · 2017: 30 · 2016: 41 · 2015: 41 · 2014: 41 · 2013: 51 · 2012: 29
FWCI
2.73
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Best Practice & Research Clinical Rheumatology (publishedVersion)
  • PubMed (publishedVersion)
  • VU Research Portal (publishedVersion)
  • Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Topics
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy-related medical research
Keywords
low back pain, non-specific low back pain, chronic low back pain, red flags, yellow flags, prevalence, economic burden, chronic widespread pain, disability prevention, physical activity, exercise programmes, analgesics, nonsteroidal anti-inflammatory drugs, muscle relaxants, manual therapy, behavioral interventions, multidisciplinary treatment, prognosis
MeSH terms
Humans, Life Style, Physical Fitness, Risk Factors, Low Back Pain, Physical Therapy Modalities

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