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Low back pain (non-specific)
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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“Importantly, the onset of MSK pain can result in a downward spiral of negative physical, social, and psychological consequences, which can lead to chronic MSK pain [4–9].”
From Telerehabilitation of acute musculoskeletal multi-disorders: prospective, single-arm, interventional study (2022) · cites this paper as [9]
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Metadata
- 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)
- 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
- 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 › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Spine and Intervertebral Disc Pathology
- Health Sciences › Medicine › Obstetrics and Gynecology › 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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