Published 22 December 2008, doi:10.1136/bmj.a2718
Cite this as: BMJ 2008;337:a2718

Clinical Review

Management of low back pain

Steven P Cohen, associate professor and director of medical education, director of pain research1,2, Charles E Argoff, professor and director3, Eugene J Carragee, professor and vice chairman, chief4,5

1 Pain Management Division, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205 , 2 Department of Surgery, Walter Reed Army Medical Center, Washington, DC 20307, 3 Comprehensive Pain Program, Department of Neurology, Albany Medical College, Albany, NY 12208, 4 Department of Orthopedic Surgery, Division of Spine Surgery, Stanford University School of Medicine, Stanford, CA 94305, 5 Division of Spine Surgery, Stanford University School of Medicine, Stanford, CA

Correspondence to: Professor S P Cohen, 550 North Broadway, Suite 301, Baltimore, MD 21205 scohen40@jhmi.edu

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


Most people will at some time experience an episode of serious low back pain, but most cases resolve with minimal intervention
The main value of a history and physical examination is to determine which patients should be referred for imaging and interventions
Early magnetic resonance imaging has not been shown to improve outcomes for low back pain
The risk factors for progression to chronic back pain are predominantly psychosocial and occupational.
Most treatments for chronic low back pain have a small effect and/or afford transient benefits


Back pain is the leading cause of occupational disability in the world and the most common cause of missed workdays. As the population ages and our lives become more sedentary, this situation is unlikely to change. We aim here to provide an evidence based overview of low back pain aimed at primary care physicians.

The most frequently quoted epidemiological studies cite lifetime adult prevalence . . . [Full text of this article]

Mechanical (80-90%)
Neurogenic (5-15%)
Non-mechanical spinal conditions (1-2%)
Referred visceral pain (1-2%)
Other (2-4%)

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This article has been cited by other articles:

  • Cohen, S. P., Nguyen, C., Kapoor, S. G., Anderson-Barnes, V. C., Foster, L., Shields, C., McLean, B., Wichman, T., Plunkett, A. (2009). Back Pain During War: An Analysis of Factors Affecting Outcome. Arch Intern Med 169: 1916-1923 [Abstract] [Full text]  

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