What low back pain is and why we need to pay attention
Open accessAbstract
Low back pain is a very common symptom. It occurs in high-income, middle-income, and low-income countries and all age groups from children to the elderly population. Globally, years lived with disability caused by low back pain increased by 54% between 1990 and 2015, mainly because of population increase and ageing, with the biggest increase seen in low-income and middle-income countries. Low back pain is now the leading cause of disability worldwide. For nearly all people with low back pain, it is not possible to identify a specific nociceptive cause. Only a small proportion of people have a well understood pathological cause-eg, a vertebral fracture, malignancy, or infection. People with physically demanding jobs, physical and mental comorbidities, smokers, and obese individuals are at greatest risk of reporting low back pain. Disabling low back pain is over-represented among people with low socioeconomic status. Most people with new episodes of low back pain recover quickly; however, recurrence is common and in a small proportion of people, low back pain becomes persistent and disabling. Initial high pain intensity, psychological distress, and accompanying pain at multiple body sites increases the risk of persistent disabling low back pain. Increasing evidence shows that central pain-modulating mechanisms and pain cognitions have important roles in the development of persistent disabling low back pain. Cost, health-care use, and disability from low back pain vary substantially between countries and are influenced by local culture and social systems, as well as by beliefs about cause and effect. Disability and costs attributed to low back pain are projected to increase in coming decades, in particular in low-income and middle-income countries, where health and other systems are often fragile and not equipped to cope with this growing burden. Intensified research efforts and global initiatives are clearly needed to address the burden of low back pain as a public health problem.
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Mental factors such as cognition, emotions, and expectations play a significant role in the experience of pain.
“Mental factors such as cognition, emotions, and expectations play a significant role in the experience of pain [7].”
From Benefits, Recruitment, Dropout, and Acceptability of the Strength Back Digital Health Intervention for Patients Undergoing Spinal Surgery: Nonrandomized, Qualitative, and Quantitative Pilot Feasibility Study (2024) · cites this paper as [7]
The ‘Central pain processing and modulation’ section says cognition and emotion can alter responses to the same nociceptive input in chronic pain. The ‘Psychological factors’ section also links beliefs to pain perception, but the paper does not establish the claim for pain generally or specifically identify expectations as a factor in pain experience. (LLM, conf=0.82)
Experimental — accuracy not yet measuredPsychological factors have an important role in an individual's experience of low back pain and its impact on functioning and quality of life.
“Psychological factors have an important role in an individual’s experience of LBP and its impact on their functioning and quality of life.”
From Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis (2022) · cites this paper as [1]
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Psychological Treatment Strategy for Chronic Low Back Pain
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Self-citationTGF-β1-supplemented decellularized annulus fibrosus matrix hydrogels promote annulus fibrosus repair
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“Given the impaired physical function, quality of life, and even social participation from chronic low back pain [9], it is a global priority to establish an effective treatment [6,10,11].”
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Analgesia for non-specific low back pain
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“Low back pain is a very common condition that occurs in people in different regions (developed and developing countries) and at different ages (from children to the elderly) [1].”
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“The substantial financial and functional burden on the global population is thoroughly documented [1], and projections indicate that the largest contributor among MSK disorders, low back pain, will increase further in the years to come [2].”
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A user-centered approach to design a mobile application for chronic pain management
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“Mental factors such as cognition, emotions, and expectations play a significant role in the experience of pain [7].”
Background
- Authors
- Hartvigsen, J., Hancock, M. J., Kongsted, A., Louw, Q., Ferreira, M. L., Genevay, S., Hoy, D., Karppinen, J., Pransky, G., Sieper, J., Smeets, R. J., Underwood, M., Buchbinder, R., Hartvigsen, J., Cherkin, D., Foster, N. E., Maher, C. G., Underwood, M., van Tulder, M., Anema, J. R., Chou, R., Cohen, S. P., Menezes Costa, L., Croft, P., Ferreira, M., Ferreira, P. H., Fritz, J. M., Genevay, S., Gross, D. P., Hancock, M. J., Hoy, D., Karppinen, J., Koes, B. W., Kongsted, A., Louw, Q., Öberg, B., Peul, W. C., Pransky, G., Schoene, M., Sieper, J., Smeets, R. J., Turner, J. A., & Woolf, A.
- Affiliations
- The University of Sydney (AU)
- University of Southern Denmark (DK)
- Macquarie University (AU)
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2018-06
- Volume
- 391
- Issue
- 10137
- Pages
- 2356-2367
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2790410554
- Cited by
- 4,652
- References
- 123
- Citations by year
- 2026: 553 · 2025: 657 · 2024: 732 · 2023: 664 · 2022: 684 · 2021: 595 · 2020: 398 · 2019: 266 · 2018: 90 · 2017: 1 · 2013: 2
- FWCI
- 39.36
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- VU Research Portal (publishedVersion, other-oa)
- University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion, cc-by-nc-nd)
- Archive ouverte UNIGE (University of Geneva) (publishedVersion)
- Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Funders
- University of Washington
- University of Alberta
- National Institute for Health and Care Research (NF-SI-0512-10103, NF-SI-0616-10043, NF-SI-0515-10095, NIHR-RP-011-015)
- University of Exeter
- Macquarie University
- Universiteit Leiden
- Universiteit Maastricht
- Universiteit Stellenbosch
- Oulun Yliopisto
- Syddansk Universitet
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Keywords
- low back pain, disability burden, socioeconomic status, risk factors, central pain modulation, pain-related cognitions, health care costs, global burden of disease, low- and middle-income countries
- MeSH terms
- Adult, Aged, Attention, Cost-Benefit Analysis, Delivery of Health Care, Female, Persons with Disabilities, Disabled Persons, Humans, Male, Middle Aged, Recurrence, Social Class, Low Back Pain, Cost of Illness
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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