Introduction to nonspecific low back pain

Costa-Black, 2010Dionne, 2006Hayden, 2010Kamper, 2012Maher, 2017Pinheiro, 2015Steffens, 2016Walker, 2004

About 80% of people will experience an episode of nonspecific low back pain at some time in their lives. It is most common between the ages of 35 and 55 years and its severity increases with age up to 80 yearsHartvigsen, 2018. Most episodes are acute and mild, but the prevalence of chronic severe, disabling pain increases with age (see Prognosis in nonspecific low back pain). While many people can self-manage, up to half of those with an episode of back pain will seek medical care, most in the primary care setting. The spectrum of presentations is broad, with some patients experiencing severe pain and disability, typically for short periods of time. Adolescents and children also experience nonspecific low back pain, and unresolved pain in youth is a predictor of pain in adulthood.

For information about the assessment of patients with low back pain, see Assessment of back and neck pain. Lumbar spine imaging has no utility in patients with nonspecific low back pain, but may be considered if neurological symptoms or signs are present or a serious pathology is suspected clinically—see Utility of imaging for assessment of back and neck pain.

Risk factors for developing nonspecific low back pain include heavy physical work; frequent bending, twisting, or lifting; and prolonged static postures. Symptoms of depression and lifestyle factors (eg tobacco smoking, obesity, physical inactivity) are also associated with nonspecific low back pain. Exercise may have a protective effect against nonspecific low back pain.

The Australian Commission on Safety and Quality in Health Care Low Back Pain Clinical Care Standard aims to ensure that people receive best-practice care for low back pain, regardless of where they are treated in Australia. It contains 8 quality statements that describe the level of clinical care expected, and a set of indicators to support monitoring and quality improvement.