Editing Low back pain (section)

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{{Infobox medical condition (new)
| name            = Low back pain
| image           = Lumbar region in human skeleton.svg
| caption         = Location of the [[lumbar]] region (pink) in relation to the human skeleton
| field           = [[Orthopedics]], [[rheumatology]], [[rehabilitation medicine]]
| synonyms        = Lower back pain, lumbago
| pronounce       = Lumbago {{IPAc-en|l|ʌ|m|ˈ|b|eɪ|ɡ|oʊ}}
| symptoms        = 
| complications   = 
| onset           = 20 to 40&nbsp;years of age<ref name=casazza_2012/>
| duration        = ~65% get better in 6 weeks<ref name=menezes_2012/>
| types           = Acute (less than 6 weeks), sub-chronic (6 to 12 weeks), chronic (more than 12 weeks)<ref name=koes_2010/>
| causes          = Usually non-specific, occasionally significant underlying cause<ref name=casazza_2012/><ref name=NIH2015/>
| risks           = 
| diagnosis       = [[Medical imaging]] (if ''red flags'')<ref name=manusov_2012_diag/>
| differential    = 
| prevention      = 
| treatment       = Continued normal activity, non-medication based treatments, NSAIDs<ref name=menezes_2012/><ref name=Qas2017/>
| medication      = 
| prognosis       = 
| frequency       = ~25% in any given month<ref name=hoy_2012/><ref name=vos_2012/>
| deaths          = 
}}
<!-- Definition and symptoms -->

'''Low back pain''' or [[wiktionary:lumbago#Etymology|'''lumbago''']] is a common [[musculoskeletal disorders|disorder involving the muscles, nerves, and bones]] of the [[back]], in between the lower edge of the ribs and the lower fold of the buttocks. [[Pain]] can vary from a dull constant ache to a sudden sharp feeling.<ref name="NIH2015">{{cite web |date=3 November 2015 |title=Low Back Pain Fact Sheet |url=http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm |url-status=live |archive-url=https://web.archive.org/web/20160304051951/http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm |archive-date=4 March 2016 |access-date=5 March 2016 |website=National Institute of Neurological Disorders and Stroke}}</ref> Low back pain may be classified by [[Pain#Chronic versus acute|duration]] as acute (pain lasting less than 6 weeks), sub-chronic (6 to 12 weeks), or chronic (more than 12 weeks).<ref name=koes_2010>{{cite journal | vauthors = Koes BW, van Tulder M, Lin CW, Macedo LG, McAuley J, Maher C | title = An updated overview of clinical guidelines for the management of non-specific low back pain in primary care | journal = European Spine Journal | volume = 19 | issue = 12 | pages = 2075–2094 | date = December 2010 | pmid = 20602122 | pmc = 2997201 | doi = 10.1007/s00586-010-1502-y }}</ref> The condition may be further classified by the underlying cause as either mechanical, non-mechanical, or [[referred pain]].<ref name=manusov_2012_diag>{{cite journal | vauthors = Manusov EG | title = Evaluation and diagnosis of low back pain | journal = Primary Care | volume = 39 | issue = 3 | pages = 471–479 | date = September 2012 | pmid = 22958556 | doi = 10.1016/j.pop.2012.06.003 }}</ref> The symptoms of low back pain usually improve within a few weeks from the time they start, with 40–90% of people recovered by six weeks.<ref name=menezes_2012>{{cite journal | vauthors = ((da C Menezes Costa L)), Maher CG, Hancock MJ, McAuley JH, Herbert RD, Costa LO | title = The prognosis of acute and persistent low-back pain: a meta-analysis | journal = CMAJ | volume = 184 | issue = 11 | pages = E613–E624 | date = August 2012 | pmid = 22586331 | pmc = 3414626 | doi = 10.1503/cmaj.111271 }}</ref>

<!--Cause and diagnosis  -->
In most episodes of low back pain a specific underlying cause is not identified or even looked for, with the pain believed to be due to mechanical problems such as [[muscle strain|muscle]] or [[joint strain]].<ref name=casazza_2012>{{cite journal | vauthors = Casazza BA | title = Diagnosis and treatment of acute low back pain | journal = American Family Physician | volume = 85 | issue = 4 | pages = 343–350 | date = February 2012 | pmid = 22335313 }}</ref><ref name=NIH2015/> If the pain does not go away with conservative treatment or if it is accompanied by "red flags" such as unexplained weight loss, [[fever]], or significant problems with feeling or movement, further testing may be needed to look for a serious underlying problem.<ref name=manusov_2012_diag/> In most cases, imaging tools such as [[X-ray computed tomography]] are not useful or recommended for low back pain that lasts less than 6 weeks (with no red flags) and carry their own risks.<ref>{{Cite web |last1=American Academy of Family Physicians |last2=Choosing Wisely |date=2023 |title=Imaging for Low Back Pain |url=https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/cw-back-pain.html |access-date=2023-07-21 |website=aafp.org}}</ref> Despite this, the use of imaging in low back pain has increased.<ref name=deyo_2009>{{cite journal | vauthors = Deyo RA, Mirza SK, Turner JA, Martin BI | title = Overtreating chronic back pain: time to back off? | journal = Journal of the American Board of Family Medicine | volume = 22 | issue = 1 | pages = 62–68 | year = 2009 | pmid = 19124635 | pmc = 2729142 | doi = 10.3122/jabfm.2009.01.080102 }}</ref> Some low back pain is caused by damaged [[intervertebral disc]]s, and the [[straight leg raise|straight leg raise test]] is useful to identify this cause.<ref name=manusov_2012_diag/> In those with chronic pain, the pain processing system may malfunction, causing large amounts of pain in response to non-serious events.<ref name=salzberg_2012>{{cite journal | vauthors = Salzberg L | title = The physiology of low back pain | journal = Primary Care | volume = 39 | issue = 3 | pages = 487–498 | date = September 2012 | pmid = 22958558 | doi = 10.1016/j.pop.2012.06.014 }}</ref> Chronic non-specific low back pain (CNSLBP) is a highly prevalent musculoskeletal condition that not only affects the body, but also a person's social and economic status. It would be greatly beneficial for people with CNSLBP to be screened for genetic issues, unhealthy lifestyles and habits, and psychosocial factors on top of musculoskeletal issues.<ref name="ReferenceA">{{Cite journal |last1=Herrero |first1=Pablo |last2=Val |first2=Paula |last3=Lapuente-Hernández |first3=Diego |last4=Cuenca-Zaldívar |first4=Juan Nicolás |last5=Calvo |first5=Sandra |last6=Gómez-Trullén |first6=Eva María |date=2024-02-20 |title=Effects of Lifestyle Interventions on the Improvement of Chronic Non-Specific Low Back Pain: A Systematic Review and Network Meta-Analysis |journal=Healthcare |volume=12 |issue=5 |page=505 |doi=10.3390/healthcare12050505 |doi-access=free |issn=2227-9032 |pmc=10931043 |pmid=38470617}}</ref> Chronic lower back pain is defined as back pain that lasts more than three months.<ref name=":9">{{Cite book |date=2023 |title=WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings |url=https://www.who.int/publications/i/item/9789240081789 |publisher=World Health Organization |isbn=978-92-4-008178-9}}</ref>

<!-- Treatment -->
The symptoms of low back pain usually improve within a few weeks from the time they start, with 40–90% of people recovered by six weeks.<ref name="menezes_2012" /> Normal activity should be continued as much as the pain allows.<ref name="menezes_2012" /> Initial management with non-medication based treatments is recommended.<ref name=Qas2017/> Non–medication based treatments include superficial [[Heat therapy|heat]], [[massage]], [[acupuncture]], or [[spinal manipulation]].<ref name="Qas2017" /> If these are not sufficiently effective, [[NSAIDs]] are recommended.<ref name=Qas2017>{{cite journal | vauthors = Qaseem A, Wilt TJ, McLean RM, Forciea MA, Denberg TD, Barry MJ, Boyd C, Chow RD, Fitterman N, Harris RP, Humphrey LL, Vijan S | display-authors = 6 | title = Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians | journal = Annals of Internal Medicine | volume = 166 | issue = 7 | pages = 514–530 | date = April 2017 | pmid = 28192789 | doi = 10.7326/M16-2367 | doi-access = free }}</ref><ref>{{Cite journal |last1=Cashin |first1=Aidan G. |last2=Wand |first2=Benedict M. |last3=O'Connell |first3=Neil E. |last4=Lee |first4=Hopin |last5=Rizzo |first5=Rodrigo Rn |last6=Bagg |first6=Matthew K. |last7=O'Hagan |first7=Edel |last8=Maher |first8=Christopher G. |last9=Furlan |first9=Andrea D. |last10=van Tulder |first10=Maurits W. |last11=McAuley |first11=James H. |date=2023-04-04 |title=Pharmacological treatments for low back pain in adults: an overview of Cochrane Reviews |journal=The Cochrane Database of Systematic Reviews |volume=2023 |issue=4 |pages=CD013815 |doi=10.1002/14651858.CD013815.pub2 |issn=1469-493X |pmc=10072849 |pmid=37014979}}</ref> A number of other options are available for those who do not improve with usual treatment. [[Opioid]]s may be useful if simple pain medications are not enough, but they are not generally recommended due to side effects,<ref name=":5" /> including high rates of addiction, accidental overdose and death.<ref name=":6" /> Surgery may be beneficial for those with disc-related chronic pain and disability or [[spinal stenosis]].<ref name=manusov_2012_surg/><ref name=chou_2009_surgery>{{cite journal | vauthors = Chou R, Baisden J, Carragee EJ, Resnick DK, Shaffer WO, Loeser JD | title = Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline | journal = Spine | volume = 34 | issue = 10 | pages = 1094–1109 | date = May 2009 | pmid = 19363455 | doi = 10.1097/BRS.0b013e3181a105fc | s2cid = 1504909 }}</ref> No clear benefit of surgery has been found for other cases of non-specific low back pain.<ref name=manusov_2012_surg>{{cite journal | vauthors = Manusov EG | title = Surgical treatment of low back pain | journal = Primary Care | volume = 39 | issue = 3 | pages = 525–531 | date = September 2012 | pmid = 22958562 | doi = 10.1016/j.pop.2012.06.010 }}</ref> Low back pain often affects mood, which may be improved by [[psychological counseling|counseling]] or [[antidepressant]]s.<ref name="miller_2012">{{cite journal |vauthors=Miller SM |date=September 2012 |title=Low back pain: pharmacologic management |journal=Primary Care |volume=39 |issue=3 |pages=499–510 |doi=10.1016/j.pop.2012.06.005 |pmid=22958559}}</ref><ref name=henschke_2010>{{cite journal | vauthors = Henschke N, Ostelo RW, van Tulder MW, Vlaeyen JW, Morley S, Assendelft WJ, Main CJ | title = Behavioural treatment for chronic low-back pain | journal = The Cochrane Database of Systematic Reviews | issue = 7 | pages = CD002014 | date = July 2010 | volume = 2011 | pmid = 20614428 | pmc = 7065591 | doi = 10.1002/14651858.CD002014.pub3 }}</ref> Additionally, there are many [[alternative medicine]] therapies, but there is not enough evidence to recommend them confidently.<ref name=marlowe_2012/> The evidence for [[chiropractic]] care<ref name=walker_2011>{{cite journal | vauthors = Walker BF, French SD, Grant W, Green S | title = A Cochrane review of combined chiropractic interventions for low-back pain | journal = Spine | volume = 36 | issue = 3 | pages = 230–242 | date = February 2011 | pmid = 21248591 | doi = 10.1097/BRS.0b013e318202ac73 | s2cid = 26310171 }}</ref> and [[spinal manipulation]] is mixed.<ref name=marlowe_2012>{{cite journal | vauthors = Marlowe D | title = Complementary and alternative medicine treatments for low back pain | journal = Primary Care | volume = 39 | issue = 3 | pages = 533–546 | date = September 2012 | pmid = 22958563 | doi = 10.1016/j.pop.2012.06.008 }}</ref><ref name=dagenais_2010>{{cite journal | vauthors = Dagenais S, Gay RE, Tricco AC, Freeman MD, Mayer JM | title = NASS Contemporary Concepts in Spine Care: spinal manipulation therapy for acute low back pain | journal = The Spine Journal | volume = 10 | issue = 10 | pages = 918–940 | date = October 2010 | pmid = 20869008 | doi = 10.1016/j.spinee.2010.07.389 }}</ref><ref name=rubinstein_2011>{{cite journal | vauthors = Rubinstein SM, van Middelkoop M, Assendelft WJ, de Boer MR, van Tulder MW | title = Spinal manipulative therapy for chronic low-back pain | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD008112 | date = February 2011 | pmid = 21328304 | doi = 10.1002/14651858.CD008112.pub2 | hdl-access = free | veditors = Rubinstein SM | hdl = 1887/117578 }}</ref><ref name=rubinstein_2012>{{cite journal | vauthors = Rubinstein SM, Terwee CB, Assendelft WJ, de Boer MR, van Tulder MW | title = Spinal manipulative therapy for acute low-back pain | journal = The Cochrane Database of Systematic Reviews | volume = 9 | issue = 9 | pages = CD008880 | date = September 2012 | pmid = 22972127 | pmc = 6885055 | doi = 10.1002/14651858.CD008880.pub2 | hdl = 1871/48563 }}</ref>

<!-- Epidemiology -->
Approximately 9–12% of people (632&nbsp;million) have low back pain at any given point in time,<ref name=":4">{{cite journal | vauthors = Ferreira ML, de Luca K, Haile LM, Steinmetz JD, Culbreth GT, Cross M, Kopec JA, Ferreira PH, Blyth FM, Buchbinder R, Hartvigsen J | display-authors = 6 | collaboration = GBD 2021 Low Back Pain Collaborators | title = Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021 | journal = The Lancet. Rheumatology | volume = 5 | issue = 6 | pages = e316–e329 | date = June 2023 | pmid = 37273833 | pmc = 10234592 | doi = 10.1016/S2665-9913(23)00098-X }}</ref> and nearly 25% report having it at some point over any one-month period.<ref name=hoy_2012/><ref name=vos_2012>{{cite journal | vauthors = Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basáñez MG, Baxter A, Bell ML, Benjamin EJ, Bennett D, Bernabé E, Bhalla K, Bhandari B, Bikbov B, Bin Abdulhak A, Birbeck G, Black JA, Blencowe H, Blore JD, Blyth F, Bolliger I, Bonaventure A, Boufous S, Bourne R, Boussinesq M, Braithwaite T, Brayne C, Bridgett L, Brooker S, Brooks P, Brugha TS, Bryan-Hancock C, Bucello C, Buchbinder R, Buckle G, Budke CM, Burch M, Burney P, Burstein R, Calabria B, Campbell B, Canter CE, Carabin H, Carapetis J, Carmona L, Cella C, Charlson F, Chen H, Cheng AT, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahiya M, Dahodwala N, Damsere-Derry J, Danaei G, Davis A, De Leo D, Degenhardt L, Dellavalle R, Delossantos A, Denenberg J, Derrett S, Des Jarlais DC, Dharmaratne SD, Dherani M, Diaz-Torne C, Dolk H, Dorsey ER, Driscoll T, Duber H, Ebel B, Edmond K, Elbaz A, Ali SE, Erskine H, Erwin PJ, Espindola P, Ewoigbokhan SE, Farzadfar F, Feigin V, Felson DT, Ferrari A, Ferri CP, Fèvre EM, Finucane MM, Flaxman S, Flood L, Foreman K, Forouzanfar MH, Fowkes FG, Franklin R, Fransen M, Freeman MK, Gabbe BJ, Gabriel SE, Gakidou E, Ganatra HA, Garcia B, Gaspari F, Gillum RF, Gmel G, Gosselin R, Grainger R, Groeger J, Guillemin F, Gunnell D, Gupta R, Haagsma J, Hagan H, Halasa YA, Hall W, Haring D, Haro JM, Harrison JE, Havmoeller R, Hay RJ, Higashi H, Hill C, Hoen B, Hoffman H, Hotez PJ, Hoy D, Huang JJ, Ibeanusi SE, Jacobsen KH, James SL, Jarvis D, Jasrasaria R, Jayaraman S, Johns N, Jonas JB, Karthikeyan G, Kassebaum N, Kawakami N, Keren A, Khoo JP, King CH, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Lalloo R, Laslett LL, Lathlean T, Leasher JL, Lee YY, Leigh J, Lim SS, Limb E, Lin JK, Lipnick M, Lipshultz SE, Liu W, Loane M, Ohno SL, Lyons R, Ma J, Mabweijano J, MacIntyre MF, Malekzadeh R, Mallinger L, Manivannan S, Marcenes W, March L, Margolis DJ, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGill N, McGrath J, Medina-Mora ME, Meltzer M, Mensah GA, Merriman TR, Meyer AC, Miglioli V, Miller M, Miller TR, Mitchell PB, Mocumbi AO, Moffitt TE, Mokdad AA, Monasta L, Montico M, Moradi-Lakeh M, Moran A, Morawska L, Mori R, Murdoch ME, Mwaniki MK, Naidoo K, Nair MN, Naldi L, Narayan KM, Nelson PK, Nelson RG, Nevitt MC, Newton CR, Nolte S, Norman P, Norman R, O'Donnell M, O'Hanlon S, Olives C, Omer SB, Ortblad K, Osborne R, Ozgediz D, Page A, Pahari B, Pandian JD, Rivero AP, Patten SB, Pearce N, Padilla RP, Perez-Ruiz F, Perico N, Pesudovs K, Phillips D, Phillips MR, Pierce K, Pion S, Polanczyk GV, Polinder S, Pope CA, Popova S, Porrini E, Pourmalek F, Prince M, Pullan RL, Ramaiah KD, Ranganathan D, Razavi H, Regan M, Rehm JT, Rein DB, Remuzzi G, Richardson K, Rivara FP, Roberts T, Robinson C, De Leòn FR, Ronfani L, Room R, Rosenfeld LC, Rushton L, Sacco RL, Saha S, Sampson U, Sanchez-Riera L, Sanman E, Schwebel DC, Scott JG, Segui-Gomez M, Shahraz S, Shepard DS, Shin H, Shivakoti R, Singh D, Singh GM, Singh JA, Singleton J, Sleet DA, Sliwa K, Smith E, Smith JL, Stapelberg NJ, Steer A, Steiner T, Stolk WA, Stovner LJ, Sudfeld C, Syed S, Tamburlini G, Tavakkoli M, Taylor HR, Taylor JA, Taylor WJ, Thomas B, Thomson WM, Thurston GD, Tleyjeh IM, Tonelli M, Towbin JA, Truelsen T, Tsilimbaris MK, Ubeda C, Undurraga EA, van der Werf MJ, van Os J, Vavilala MS, Venketasubramanian N, Wang M, Wang W, Watt K, Weatherall DJ, Weinstock MA, Weintraub R, Weisskopf MG, Weissman MM, White RA, Whiteford H, Wiersma ST, Wilkinson JD, Williams HC, Williams SR, Witt E, Wolfe F, Woolf AD, Wulf S, Yeh PH, Zaidi AK, Zheng ZJ, Zonies D, Lopez AD, Murray CJ, AlMazroa MA, Memish ZA | display-authors = 6 | title = Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010 | journal = Lancet | volume = 380 | issue = 9859 | pages = 2163–2196 | date = December 2012 | pmid = 23245607 | pmc = 6350784 | doi = 10.1016/S0140-6736(12)61729-2 }}</ref> About 40% of people have low back pain at some point in their lives,<ref name=hoy_2012/> with estimates as high as 80% among people in the [[developed world]].<ref name=malhotra_2011>{{cite book |author1=Vinod Malhotra |author2=Yao, Fun-Sun F. |author3=Fontes, Manuel da Costa |title=Yao and Artusio's Anesthesiology: Problem-Oriented Patient Management |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2011 |pages=Chapter 49 |isbn=978-1-4511-0265-9 |url=https://books.google.com/books?id=qOhuwkoN15MC&pg=PT1390 |url-status=live |archive-url=https://web.archive.org/web/20170908185118/https://books.google.com/books?id=qOhuwkoN15MC&pg=PT1390 |archive-date=8 September 2017 }}</ref> Low back pain is the greatest contributor to lost productivity, absenteeism, disability and early retirement worldwide.<ref name=":4" /> Difficulty with low back pain most often begins between 20 and 40 years of age.<ref name=casazza_2012/> Women and older people have higher estimated rates of lower back pain and also higher disability estimates.<ref name=":9" /> Low back pain is more common among people aged between 40 and 80 years, with the overall number of individuals affected expected to increase as the population ages.<ref name=hoy_2012>{{cite journal | vauthors = Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, Woolf A, Vos T, Buchbinder R | display-authors = 6 | title = A systematic review of the global prevalence of low back pain | journal = Arthritis and Rheumatism | volume = 64 | issue = 6 | pages = 2028–2037 | date = June 2012 | pmid = 22231424 | doi = 10.1002/art.34347 | doi-access = free }}</ref> According to the World Health Organizations, lower back pain is the top medical condition world-wide from which the most number of people world-wide can benefit from improved rehabilitation.<ref name=":9" />
[[File:Low Back Pain.webm|thumb|upright=1.3|Video explanation]]
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