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Low back pain (LBP) is common, increasingly prevalent and the leading cause of lost productivity worldwide. Most LBP is generated by non‐specific degenerative changes affecting the bone and soft tissue of the spine, with congenital and acquired deformity, infection, malignancy and trauma comprising a much smaller cohort. It is estimated to account for $4.8 billion in lost annual individual earnings, $622 million in additional welfare repayments and $2.9 billion in lost gross domestic product in Australia alone. 

Acute LBP resolves in many patients, but recurrence is common and about 60% will develop chronic pain. This transition is perpetuated by a complex interaction of anatomical, biological, psychological and social factors and, as with other forms of chronic pain, is best addressed with an integrated, comprehensive and multidisciplinary pain management program rather than fragmented care. A significant proportion of patients with chronic LBP seek care from their general practitioner and, contrary to the recommendation of several guidelines, a little over half of patients in high income countries undergo spinal imaging. 

Given the high rates of imaging abnormalities of degenerative spinal disease in both symptomatic and asymptomatic individuals (34.4% of asymptomatic patients in one meta‐analysis), the findings frequently prompt referral to a spinal surgeon.

This MJA narrative shares more.

Details

• Explain key components of the perspective.
• List main findings.
• Recognise the role of spinal surgery in the treatment of low back pain

Author: Lachlan Evans, Thomas O’Donohoe, Andrew Morokoff and Katharine Drummond

Article Type: Narrative review