Intended for healthcare professionals

Practice ABC of Pain

Management of Low Back Pain

BMJ 2013; 347 doi: (Published 05 December 2013) Cite this as: BMJ 2013;347:bmj.f3148
  1. James Campbell1,
  2. Lesley A Colvin2
  1. 1Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
  2. 2Department of Anaesthesia, Critical Care & Pain Medicine, Western General Hospital, University of Edinburgh, Edinburgh, UK

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  • Low back pain is extremely common and infrequently has serious underlying pathology

  • A small, but significant, percentage of people affected by back pain develop a chronic problem with associated disability

  • Appropriate early diagnosis and management reduces disability

  • The evidence for effectiveness of injection therapies is limited, but selected patients may benefit from appropriate interventions

  • Although total resolution of pain is often not possible, a key aim of management is to avoid chronicity and encourage effective self management


While the majority of adults will have suffered from back pain at some point in their life, it is usually a minor self-limiting condition. Pain in the lower back is extremely common: around 60% of the adult population can expect to have a back problem at some time in their life. Although most back pain is generally benign a significant percentage of the population will develop chronic pain and disability (Box 1). The vast majority of adults with low back pain are labelled as having ‘mechanical low back pain’, which implies that there is a problem with the mechanism of the back for which a generic treatment package is probably appropriate in the first instance.

Box 1

Low Back Pain and Disability

  • 3–4% of young adults (below are 45) are chronically disabled by low back pain

  • 5–7% of older adults (45+ years) are chronically disabled by low back pain


The mechanical problem may be structural (e.g. disc pathology, facet joint arthropathy), but frequently is a ‘mechanical dysfunction’, where the normal …

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