Rheumatology Search
Rheumatology Rheumatology
low%20back%20pain
LOW BACK PAIN
It is pain, stiffness, or discomfort in the lower back area below the costal margin & above the gluteal creases.
Low back pain is also called spinal pain or lumbago.
Nonspecific low back pain is without identifiable specific causes that makes up 85-90% of all low back pain cases.  It also includes pain felt in the proximal lower extremities
Patients with low back pain maybe associated with mobility deficits caused by severe or progressive neurologic disorders or comorbidities.
Specific spinal pathology includes cauda equina syndrome, tumor, infection, ankylosing spondylitis, inflammatory disorders.
Low back pain associated w/ radiculopathy or spinal stenosis are dermatomal pain w/ or w/o neurologic deficits that most often caused by nerve root compression.

  1. Airaksinen O, Hildebrandt J, Mannion AF, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006 Mar(15)(Suppl 2):S192-S300. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3454542/pdf/586_2006_Article_1072.pdf. PMID: 16550448
  2. Chou R, Huffman LH. Evaluation and management of low back pain: evidence review. American Pain Society website. http://americanpainsociety.org/uploads/education/guidelines/evaluation-management-lowback-pain.pdf. 2007.
  3. Chou R, Huffman LH; American Pain Society; American College of Physicians. Medications for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007 Oct;147(7):505-514. http://annals.org/data/Journals/AIM/20145/0000605-200710020-00008.pdf. PMID: 17909211
  4. Chou R, Huffman LH; American Pain Society; American College of Physicians. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007 Oct;147(7):492-504. http://annals.org/data/Journals/AIM/20145/0000605-200710020-00007.pdf. PMID: 17909210
  5. Chou R, Qaseem A, Snow V, et al; Clinical Efficacy Assessment Subcommittee of the American College of Physicians; American College of Physicians; American Pain Society Low Back Pain Guidelines Panel. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007 Oct;147(7):478-491. http://annals.org/data/Journals/AIM/20145/0000605-200710020-00006.pdf. PMID: 17909209
  6. Delitto A, George SZ, Van Dillen LR, et al; Orthopaedic Section of the American Physical Therapy Association. Low back pain. J Orthop Sports Phys Ther. 2012 Apr;42(4):A1-A57. doi: 10.2519/jospt.2012.0301. PMID: 22466247
  7. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976). 2000 Nov;25(22):2940-2952; discussion 2952. http://www.womenshealthapta.org/wp-content/uploads/2013/12/Oswestry-Fairbanks.pdf. PMID: 11074683
  8. Goertz M, Thorson D, Bonsell J, et al. Adult acute and subacute low back pain. Institute for Clinical Systems Improvement (ICSI) website. https://www.icsi.org/_asset/bjvqrj/LBP.pdf. Nov 2012.
  9. Hooten WM, Timming R, Belgrade M, et al. Assessment and management of chronic pain. Institute for Clinical Systems Improvement (ICSI) website. https://www.icsi.org/_asset/bw798b/ChronicPain.pdf. Nov 2013.
  10. Kuijer PP, Verbeek JH, Visser B, et al. An evidence-based multidisciplinary practice guideline to reduce the workload due to lifting for preventing work-related low back pain. Ann Occup Environ Med. 2014 Jun;26:16. doi: 10.1186/2052-4374-26-16. Accessed 18 Apr 2015. PMID: 24999432
  11. Manchikanti L, Abdi S, Atluri S, et al. An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain. Part II: guidance and recommendations. Pain Physician. 2013 Apr;16(Suppl 2):S49-S83. http://www.painphysicianjournal.com/2013/april/2013;16;S49-S283-final.pdf. PMID: 23615883
  12. National Institute for Health and Care Excellence (NICE). Low back pain: early management of persistent non-specific low back pain. NICE clinical guideline 88. National Institute for Health and Care Excellence (NICE). http://www.nice.org.uk/guidance/cg88/resources/guidance-low-back-pain-pdf. May 2009.
  13. Pillastrini P, Gardenghi I, Bonetti F, et al. An updated overview of clinical guidelines for chronic low back pain management in primary care. Joint Bone Spine. 2012 Mar;79(2):176-185. doi: 10.1016/j.jbspin.2011.03.019. PMID: 21565540
  14. Scottish Intercollegiate Guidelines Network (SIGN). Management of chronic pain. Scottish Intercollegiate Guidelines Network (SIGN) website. http://www.sign.ac.uk/pdf/SIGN136.pdf. Dec 2013.
  15. Singh D, Mansor M, Vijayan R, et al. The Malaysian low back pain management guidelines. 1st ed. Malaysian Association of the Study of Pain website. http://www.masp.org.my/index.cfm?menuid=23. 2009.
  16. Talmage JB, Belcourt R, Galper J, et al. Low back disorders. In: Hegmann KT. Occupational medicine practice guidelines. Evaluation and management of common health problems and functional recovery in workers. 3rd ed. Elk Grove Village (IL): American College of Occupational and Environmental Medicine (ACOEM); 2011. http://www.guideline.gov/content.aspx?id=38438. Accessed 18 Apr 2015:333-796.
  17. Chou R.. Subacute and chronic low back pain: nonpharmacologic and pharmacologic treatment. UpToDate. http://www.uptodate.com. 29 Aug 2018.
  18. Chou R, Deyo R, Friedly J, et al. Noninvasive treatments for low back pain. Comparative effectiveness review no. 169. Agency for Healthcare Research and Quality. http://www.effectivehealthcare.ahrq.gov. Feb 2016.
  19. Institute for Clinical Systems Improvement (ICSI). Health care guideline: adult acute and subacute low back pain. ICSI. http://www.icsi.org. Mar 2018.
  20. Institute of Health Economics Alberta Canada. Evidenced-informed primary care management of low back pain. Clinical practice guideline. Toward Optimized Practice website. http://www.topalbertadoctors.org. Dec 2015.
  21. Knight CL, Deyo RA, Staiger TO, et al. Treatment of acute low back pain. UpToDate. http://www.uptodate.com. 06 Dec 2017.
  22. Oliveira CB, Maher CG, Pinto RZ, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an update overview. Jul 03, 2018. Eur Spine J. doi: 10.1007/s00586-018-5673-2. PMID: 29971708
  23. Philippine Academy of Rehabilitation Medicine (PARM). Clinical practice guideline on the diagnosis and management of low back pain. PARM website. http://www.parm.com.ph. 2011.
  24. Wheeler SG, Wipf JE, Staiger TO, et al. Evaluation of low back pain in adults. UpToDate. http://www.uptodate.com. 12 Jul 2018.
  25. National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management. NICE. https://www.nice.org.uk. Nov 2016.
  26. Qaseem A, Wilt TJ, McLean RM, et al; Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017 Apr;166(7 ):514-530. doi: 10.7326/M16-2367. Accessed 20 Jul 2017. PMID: 28192789
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Rheumatology digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Obesity protects against diabetic retinopathy in type 2 diabetes
4 days ago
In patients with type 2 diabetes, obesity may be protective against vision-threatening diabetic retinopathy, a recent Korea study has shown.
Stroke recurrence risk high in patients with comorbid AF or HF
10 Jun 2019
Atrial fibrillation (AF) carries an excess risk of stroke recurrence independent of comorbidity with and heart failure (HF), while HF without AF also poses a significant risk of recurrence, a study has shown.
Enzalutamide shows potential survival benefit in metastatic hormone-sensitive prostate cancer
Roshini Claire Anthony, 3 days ago

Men with metastatic hormone-sensitive prostate cancer (mHSPC) who receive testosterone suppression therapy may have a better survival outcome with the addition of enzalutamide over other non-steroidal anti-androgen (NSAA) therapies, according to the phase III ENZAMET* trial.
Aspirin may increase rate of haemorrhagic events in elderly hypertensive patients
07 Jun 2019
Low-dose aspirin therapy does not confer significant benefits to elderly patients with hypertension, but treatment appears to increase the risk of haemorrhagic events, suggest a Japan study.