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

Clinical review

Diagnosis and treatment of low back pain

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

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

Introduction

Low back pain is a considerable health problem in all developed countries and is most commonly treated in primary healthcare settings. It is usually defined as pain, muscle tension, or stiffness localised below the costal margin and above the inferior gluteal folds, with or without leg pain (sciatica). The most important symptoms of non-specific low back pain are pain and disability. The diagnostic and therapeutic management of patients with low back pain has long been characterised by considerable variation within and between countries among general practitioners, medical specialists, and other healthcare professionals.^{1 2 w1} Recently, a large number of randomised clinical trials have been done, systematic reviews have been written, and clinical guidelines have become available. The outlook for evidence based management of low back pain has greatly improved. This review presents the current state of science regarding the diagnosis and 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

Identifying subgroups of patients more amenable to specific treatments
Clinical guidelines that stimulate a more active approach to management

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