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Prevention and treatment of low back pain: evidence, challenges, and promising directions
Open accessAbstract
Many clinical practice guidelines recommend similar approaches for the assessment and management of low back pain. Recommendations include use of a biopsychosocial framework to guide management with initial non-pharmacological treatment, including education that supports self-management and resumption of normal activities and exercise, and psychological programmes for those with persistent symptoms. Guidelines recommend prudent use of medication, imaging, and surgery. The recommendations are based on trials almost exclusively from high-income countries, focused mainly on treatments rather than on prevention, with limited data for cost-effectiveness. However, globally, gaps between evidence and practice exist, with limited use of recommended first-line treatments and inappropriately high use of imaging, rest, opioids, spinal injections, and surgery. Doing more of the same will not reduce back-related disability or its long-term consequences. The advances with the greatest potential are arguably those that align practice with the evidence, reduce the focus on spinal abnormalities, and ensure promotion of activity and function, including work participation. We have identified effective, promising, or emerging solutions that could offer new directions, but that need greater attention and further research to determine if they are appropriate for large-scale implementation. These potential solutions include focused strategies to implement best practice, the redesign of clinical pathways, integrated health and occupational interventions to reduce work disability, changes in compensation and disability claims policies, and public health and prevention strategies.
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“Across pain conditions, when hypnosis was provided adjunctively to usual care, the 95% CIs of pooled effects included what is commonly seen as clinically meaningful pain reduction (difference between groups of ≥10 points on a 101-point scale).37”
From Adjunctive use of hypnosis for clinical pain: a systematic review and meta-analysis (2024) · cites this paper as [37]
Experimental — accuracy not yet measuredIn the citing paper
“For chronic back pain, recommendations are education, exercise and psychological therapies.6–9”
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Metadata
- Authors
- Foster, N. E., Anema, J. R., Cherkin, D., Chou, R., Cohen, S. P., Gross, D. P., Ferreira, P. H., Fritz, J. M., Koes, B. W., Peul, W., Turner, J. A., Maher, C. G., 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
- Johns Hopkins University (US)
- Arthritis Research UK (GB)
- The University of Sydney (AU)
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2018-06
- Volume
- 391
- Issue
- 10137
- Pages
- 2368-2383
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2791379829
- Cited by
- 2,398
- References
- 130
- Citations by year
- 2026: 257 · 2025: 287 · 2024: 348 · 2023: 312 · 2022: 304 · 2021: 345 · 2020: 274 · 2019: 182 · 2018: 80
- FWCI
- 25.66
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion)
- Archive ouverte UNIGE (University of Geneva) (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Pure Amsterdam UMC (submittedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion)
- VU Research Portal (submittedVersion, other-oa)
- Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- Kaiser Permanente
- University of Washington
- Johns Hopkins University
- Kaiser Permanente Washington Health Research Institute
- University of Alberta
- National Institute for Health and Care Research (NF-SI-0512-10103, RP-011-015, NF-SI-0616-10043, NF-SI-0515-10095, NIHR-RP-011-015)
- University of Exeter
- University of Warwick
- Macquarie University
- Universiteit Leiden
- Monash University
- Vrije Universiteit Amsterdam
- Universiteit Maastricht
- Universiteit Stellenbosch
- Keele University
- Oulun Yliopisto
- Syddansk Universitet
- Medical Research Council
- National Health and Medical Research Council
- 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, back pain prevention, back pain management, biopsychosocial model, non-pharmacological treatment, physical activity, self-management education, psychological intervention, chronic low back pain, knowledge-practice gap, overuse of imaging, opioid overuse, spinal surgery, spinal injections, work disability, care pathways, occupational health interventions, public health prevention, cost-effectiveness
- MeSH terms
- Analgesics, Opioid, Cost-Benefit Analysis, Diagnostic Imaging, Female, Humans, Male, United States, United States Public Health Service, Low Back Pain, Practice Guidelines as Topic, Chronic Pain, Pain Management
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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