Current Guidelines for Management of Low Back Pain

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While some pharmacologic treatments will alleviate acute and subacute low back pain, the majority of patients will improve over time.
While some pharmacologic treatments will alleviate acute and subacute low back pain, the majority of patients will improve over time.

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Low back pain —also called lumbago — is defined as a common, painful condition affecting the lower portion of the spine.1 The prevalence of low back pain is reported to range between 51% and 84%, with most individuals experiencing this condition at some point in their lifetime.2 The economic burden of low back pain in the United States is significant; estimated direct costs are from $20 to $98 billion, with an estimated indirect cost as high as $200 billion annually.3 The Centers for Disease Control and Prevention reports low back pain as the second most common cause of disability, which contributes to the high overall indirect expense associated with the condition.4

The American Chiropractic Association estimates that approximately 31 million Americans will experience low back pain during their lifetime.5 Approximately 90% of all low back pain will resolve within 6 weeks, with more than 80% of cases resolving within 2 weeks.6 Low back pain is usually classified based on symptom duration, anatomical location, potential cause, and presence or absence of radicular symptoms.7 Nonradicular low back pain is pain without associated sensory distribution and nerve root involvement.7

Classification of low back pain is based on the duration of symptoms and is further divided into acute, subacute, and chronic conditions.  Acute low back pain, which is pain lasting up to 4 weeks, is usually nonspecific and has no underlying condition as an identified cause. Acute low back pain is usually self-limited and resolves on its own with nonpharmacologic treatment.  Subacute low back pain may persist for 4 to 12 weeks and may require pharmacologic therapy. Unresolved low back pain, which is pain lasting longer than 12 weeks, is classified as chronic.6,7

Acute/Subacute Low Back Pain

Both nonpharmacologic and pharmacologic therapies are available for the management of acute and subacute low back pain (Table 1).

Table 1. Nonpharmacologic and Pharmacologic Treatment for the Management of Acute and Subacute Low Back Pain

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