Prevention and treatment of low back pain: evidence, challenges, and promising directions
One article on PainSci cites Foster 2018: Complete Guide to Low Back Pain
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.
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.
related content
- “What low back pain is and why we need to pay attention,” Hartvigsen, Jan and Hancock, Mark J and Kongsted, Alice and Louw, Quinette and Ferreira, Manuela L and Genevay, Stéphane and Hoy, Damian and Karppinen, Jaro and Pransky, Glenn and Sieper, Joachim and Smeets, Rob J and Underwood, Martin and {Lancet Low Back Pain Series Working Group}, Lancet, 2018.
- “Low back pain: a call for action,” Buchbinder, Rachelle and van Tulder, Maurits and Öberg, Birgitta and Costa, Lucíola Menezes and Woolf, Anthony and Schoene, Mark and Croft, Peter and {Lancet Low Back Pain Series Working Group}, Lancet, 2018.
- “Whole of community pain education for back pain. Why does first-line care get almost no attention and what exactly are we waiting for?,” G Lorimer Moseley, British Journal of Sports Medicine, 2018.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Relationships Between Sleep Quality and Pain-Related Factors for People with Chronic Low Back Pain: Tests of Reciprocal and Time of Day Effects. Gerhart 2017 Ann Behav Med.
- Modulation in the elastic properties of gastrocnemius muscle heads in individuals with plantar fasciitis and its relationship with pain. Zhou 2020 Sci Rep.
- Association Between Plantar Fasciitis and Isolated Gastrocnemius Tightness. Nakale 2018 Foot Ankle Int.
- A Bayesian model-averaged meta-analysis of the power pose effect with informed and default priors: the case of felt power. Gronau 2017 Comprehensive Results in Social Psychology.
- The neck and headaches. Bogduk 2014 Neurol Clin.