Non-specific low back pain
Abstract
Non-specific low back pain affects people of all ages and is a leading contributor to disease burden worldwide. Management guidelines endorse triage to identify the rare cases of low back pain that are caused by medically serious pathology, and so require diagnostic work-up or specialist referral, or both. Because non-specific low back pain does not have a known pathoanatomical cause, treatment focuses on reducing pain and its consequences. Management consists of education and reassurance, analgesic medicines, non-pharmacological therapies, and timely review. The clinical course of low back pain is often favourable, thus many patients require little if any formal medical care. Two treatment strategies are currently used, a stepped approach beginning with more simple care that is progressed if the patient does not respond, and the use of simple risk prediction methods to individualise the amount and type of care provided. The overuse of imaging, opioids, and surgery remains a widespread problem.
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Many high-income countries are moving away from primarily drug and surgical management of LBP because of their associated risks and costs, and general lack of efficacy, while such interventions are increasingly provided in Nepal.
“Remarkably, although many high-income countries are moving away from primarily drug and surgical management of LBP because of their associated risks and costs, and general lack of efficacy,10 such interventions are now increasingly provided in Nepal.11 12”
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References 137 · Cited by 2,535
- Authors
- Maher, C., Underwood, M., & Buchbinder, R.
- Affiliations
- University of Warwick (GB)
- Monash University (AU)
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2017-02
- Volume
- 389
- Issue
- 10070
- Pages
- 736-747
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W3143249574
- Cited by
- 2,535
- References
- 137
- Citations by year
- 2026: 235 · 2025: 323 · 2024: 363 · 2023: 367 · 2022: 340 · 2021: 314 · 2020: 263 · 2019: 175 · 2018: 96 · 2017: 52 · 2016: 4 · 2012: 1
- FWCI
- 12.47
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute for Health and Care Research (NF-SI-0512-10103, NF-SI-0616-10043)
- 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
- non-specific low back pain, back pain management, triage, risk prediction, stepped care, analgesics, non-pharmacological treatment, patient education, overuse of imaging, opioid overuse, back surgery, disease burden
- MeSH terms
- Costs and Cost Analysis, Diagnosis, Differential, Humans, Risk Factors, Low Back Pain, Biomedical Research, Pain Management
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