Diagnosis and treatment of low back pain

doi:10.1136/bmj.332.7555.1430

BMJ 2006;332:1430-1434 (17 June), doi:10.1136/bmj.332.7555.1430

Clinical review

Diagnosis and treatment of low back pain

B W Koes, professor of general practice¹, M W van Tulder, professor of health technology assessment², S Thomas, professor of general practice¹

¹ Department of General Practice, Erasmus MC, University Medical Center Rotterdam, PO Box 1738, 3000 DR Rotterdam, Netherlands, ² EMGO Institute, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands

Correspondence to: B W Koes b.koes@erasmusmc.nl

The first 150 words of the full text of this article appear below.

Introduction

Low back pain is a considerable health problem in all developedcountries and is most commonly treated in primary healthcaresettings. It is usually defined as pain, muscle tension, orstiffness localised below the costal margin and above the inferiorgluteal folds, with or without leg pain (sciatica). The mostimportant symptoms of non-specific low back pain are pain anddisability. The diagnostic and therapeutic management of patientswith low back pain has long been characterised by considerablevariation within and between countries among general practitioners,medical specialists, and other healthcare professionals.^{1 2}^w1 Recently, a large number of randomised clinical trials havebeen done, systematic reviews have been written, and clinicalguidelines have become available. The outlook for evidence basedmanagement of low back pain has greatly improved. This reviewpresents the current state of science regarding the diagnosisand treatment of low back pain.

Sources and selection criteria

We used the Cochrane Library to . . . [Full text of this article]

Who gets it?

How is it diagnosed?

What is the prognosis?

How useful is imaging?

What are the most important prognostic indicators for chronicity?

How effective are commonly available treatments?

How effective are treatments in acute low back pain?

How effective are conservative treatments in chronic low back pain?

What is the role of invasive procedures in (non-specific) chronic low back pain?

Does (early) psychosocial intervention prevent chronicity?

What do guidelines recommend?

Promising developments

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