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Non-specific low back pain


Tags: etiology, biomechanics, back pain, pro, pain problems, spine

PainSci notes on Balagué 2012:

A key quote from the paper:

Mechanical factors have long been thought to have a causal role in low back pain. However, eight systematic reviews with the Bradford-Hill causation criteria concluded that it was unlikely that occupational sitting, awkward postures, standing and walking, manual handling or assisting patients, pushing or pulling, bending and twisting, lifting, or carrying were independently causative of low back pain in the populations of workers studied.”

A key word there is “independently,” meaning that those factors may have contributed, but they don’t appear to be capable of causing back pain on their own: some other factor is required in combination, probably a systemic vulnerability. This is how it can be both true and not true that these things cause back pain. People are generally unaware of the other factors, or unaware of their significance, but they do know when they have lifted something awkwardly.

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

Non-specific low back pain has become a major public health problem worldwide. The lifetime prevalence of low back pain is reported to be as high as 84%, and the prevalence of chronic low back pain is about 23%, with 11-12% of the population being disabled by low back pain. Mechanical factors, such as lifting and carrying, probably do not have a major pathogenic role, but genetic constitution is important. History taking and clinical examination are included in most diagnostic guidelines, but the use of clinical imaging for diagnosis should be restricted. The mechanism of action of many treatments is unclear, and effect sizes of most treatments are low. Both patient preferences and clinical evidence should be taken into account for pain management, but generally self-management, with appropriate support, is recommended and surgery and overtreatment should be avoided.

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