Low back pain

Overview

Low back pain is pain between the 12th ribs and the gluteal folds. It is the leading cause of disability worldwide: in 2020 it affected 619 million people globally, and prevalence is projected to reach 843 million cases by 2050. Lifetime prevalence reaches 84%, and about 23% of adults live with chronic low back pain.^[37][11][25]

Nearly all presentations cannot be attributed to a specific nociceptive cause. Only a small proportion have a well-understood pathological cause such as vertebral fracture, malignancy or infection. This single fact organises general-practice management: the task is not to find the lesion, but to exclude the dangerous causes, identify modifiable risk of chronicity, and keep the patient active and working.^[25]

Practice lags far behind this evidence. Globally, clinicians underuse recommended first-line treatments and overuse imaging, rest, opioids, spinal injections and surgery; Australian commentary describes the same pattern — overuse of less effective, expensive options while effective inexpensive options are underused.^[26][41]

References48ShowHide

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