Low back pain

Low back pain covers a spectrum of different types (eg, nociceptive, neuropathic and nociplastic, or non-specific) that frequently overlap. The elements comprising the lumbar spine soft tissue, vertebrae, zygapophyseal sacroiliac joints, intervertebral discs, neurovascular structures) are prone to stressors, each these, alone in combination, can contribute low pain. Due numerous factors related pain, specificity imaging diagnostic injections, methods for this condition continue be subject controversy. biopsychosocial model posits dynamic interaction between social, psychological, biological both predispose result from injury, should considered when devising interdisciplinary treatment plans. Prevention is recognised as pivotal challenge high-risk populations help tackle high health-care costs therapy rehabilitation. To large extent, depends on classification, usually starts with self-care pharmacotherapy combination non-pharmacological methods, such physical therapies psychological treatments appropriate patients. For refractory wide range non-surgical epidural steroid injections spinal cord stimulation radiofrequency ablation intra-articular mechanical pain) surgical decompression disc replacement, fusion causes) options available carefully selected Most address only single, solitary causes given complex nature multimodal approach necessary. Although globally an important health socioeconomic expected increase prevalence, continues have tremendous potential improvement therapeutic aspects. Future research focus improving accuracy objectivity assessments, algorithms consider unique biological, social factors. High-quality comparative-effectiveness randomised controlled trials longer follow-up periods aim establish efficacy cost-effectiveness management warranted. evidence gap strategiesIn their Seminar1 Nebojsa Nick Knezevic colleagues state “MRI…can higher rates surgery satisfaction rates”. Full-Text PDF strategies – Authors' replyWe thank Xing Du Yunsheng Ou bringing up contentious issue further discussion. However, we do not agree conclusions our oppose evidence-based medicine; rather, believe they bolster argument there insufficient draw firm conclusions. Seminar,1 concluded more effective than conservative stenosis, combined had no substantial benefit compared alone. We conclusion was evidence-based, could prejudice surgeon against choice stenosis.