Diagnosis and Treatment of Low Back Pain

Patient Guideline Summary

Publication Date: January 1, 2020

Last Updated: November 28, 2023

Objective

This patient summary means to discuss key recommendations from the North American Spine Society for the diagnosis and treatment of low back pain. It is limited to adults 18 years of age and older and should not be used as a reference for children.

Overview

Low back pain is a common condition resulting in serious consequences both to function and quality of life.

Symptoms include limited function and pain between the lowest ribs and the upper thighs.

The guideline and this patient summary exclude known current and former conditions like fractures, cancer, deformities, prior surgery, cancer, and pregnancy. It is limited to initially unknown causes arising from the spine that require a precise diagnosis before beginning targeted treatment.

Diagnosis

Low back pain has multiple causes that are important to identify since most treatments are specific to the cause.
Acute, sub-acute, and chronic durations of pain require different treatment plans for the best outcome.
Precise diagnosis often requires several assessments among these options:
- Discography using magnetic resonance imaging (MRI), computerized tomography (CT), or plain x-ray imaging.
- Manometry – (recording pressure inside a disc).
- Bony vibration provocation
- Psychosocial and workplace factors
- Other available indicators are either not recommended or have too little evidence to evaluate.

Treatment

Psychosocial and workplace factors are also important influences on the success of treatment.
Pain severity and functional impairment are the primary targets of treatment.
Pain medicines:
- Non-selective nonsteroidal anti-inflammatory agents (NSAIDs)
- Topical capsicum
- Opioid pain medications, cautiously prescribed and restricted to short duration
Non-drug-related:
- Physical therapy
  - Back school
  - Aerobic exercise
  - Specific stabilization exercise program
  - Spinal manipulative therapy
  - Work hardening
  - Heat
  - Massage
  - Yoga
- Laser therapy
- Acupuncture
- Acupressure
- Mckenzie method. The McKenzie Method is a simple approach for back pain. It involves specific exercises and stretches that you can do at home. The goal is to relieve pain and improve your spine's movement.
- remain active within limits of pain compared to short periods of bed rest
- Cognitive behavioral therapy
- Fear-avoidance treatments
Minimally invasive techniques: (also used for precise diagnosis)
- Thermal radiofrequency ablation of zygapophyseal (facet) joints
- Intra-articular steroid joint injections
- Intradiscal steroid injections
- Intradiscal electrothermal annuloplasty
- Biacuplasty
Successful treatment requires multiple methods, patience, and persistence.

Abbreviations

CT: Computerized Tomography
MRI: Magnetic Resonance Imaging
NSAIDs: Non-Steroidal Anti-Inflammatory Drugs

Source Citation

Kreiner DS, Matz P, Bono CM, Cho CH, Easa JE, Ghiselli G, Ghogawala Z, Reitman CA, Resnick DK, Watters WC 3rd, Annaswamy TM, Baisden J, Bartynski WS, Bess S, Brewer RP, Cassidy RC, Cheng DS, Christie SD, Chutkan NB, Cohen BA, Dagenais S, Enix DE, Dougherty P, Golish SR, Gulur P, Hwang SW, Kilincer C, King JA, Lipson AC, Lisi AJ, Meagher RJ, O'Toole JE, Park P, Pekmezci M, Perry DR, Prasad R, Provenzano DA, Radcliff KE, Rahmathulla G, Reinsel TE, Rich RL Jr, Robbins DS, Rosolowski KA, Sembrano JN, Sharma AK, Stout AA, Taleghani CK, Tauzell RA, Trammell T, Vorobeychik Y, Yahiro AM. Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of low back pain. Spine J. 2020 Jul;20(7):998-1024. doi: 10.1016/j.spinee.2020.04.006. Epub 2020 Apr 22. Erratum in: Spine J. 2021 Feb 24;: PMID: 32333996.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.