Non-specific low back pain with or without referred pain

Definition

Non-specific or mechanical LBP can be defined as pain, tension, soreness and/or stiffness in the lower back region. It is evoked by noxious stimulation of structures in the lumbar spine (Bogduk, 2009). The lower back is commonly defined as the area between the bottom of the rib cage and the buttock creases. Some individuals with non-specific LBP (NSLBP) may also feel pain in their legs, but the low back pain usually predominates.

Cause

In approximately 90% of patients with LBP no specific patho-anatomic cause can be found (CSAG,1994). Several structures in the back including the joints, discs, muscles, nerves, vascular and connective tissues may contribute to the symptoms but it is often not possible to identify a specific cause.

Prevalence

It has been estimated that 80% of the population will be affected by LBP at some point in their lives. Around 20% of people with LBP will consult their GP about LBP and this equates to 1 in 5 of the general population. The cost of this low back pain epidemic to society is significant with the loss of over 180 million days per year through sickness absence at an annual cost of approximately £6 billion. Despite this the condition only receives 1.8% of NHS spending (CSP media release, 2004).

Presentation

• Symptoms variable within the lumbar spine and lower limb
• Postural changes due to accommodation of the pain may be present
• Restricted and painful back movements
• Possible antalgic gait pattern

It is predominantly a self-limiting condition with 75-90% of primary care presentations improving within 6 weeks irrespective of the type of intervention (Jackson, 2001). However, in spite of this, 60 – 80% of patients will experience a reoccurrence of LBP in the year following their first episode (Hides et al., 1996).

X-ray and other imaging studies and investigations are not routinely required to diagnose or assess NSLBP (CKS NICE, 2015).

See general conservative treatment advice

Appropriate management of non-specific LBP has the potential to reduce the personal, social and economic impact that the condition has on both the individual and society, such as long term withdrawal from everyday activities and prolonged sickness absence from paid employment.

Progressing as expected (up to 3 Rxs) before discharge or onward referral.

Consider general progression/escalation advice.

Onward referral is not usually considered necessary for NSLBP.

75-90% better at 6/52

Clinical Standards Advisory Group. Back Pain. Report of a CSAG Committee on back pain. 1994

Bogduk N. On the definitions and physiology of back pain, referred pain, and radicular pain. Pain 2009 Dec 15;147(1-3):17-19 (link correct as at 15/2/22)

Hides JA, Richardson CA, Jull GA. Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain. Spine (Phila Pa 1976) 1996 Dec 1;21(23):2763-2769 (link correct as at 15/2/22)

Jackson DA. How is low back pain managed? Retrospective study of the first 200 patients with low back pain referred to a newly established community-based physiotherapy department. Physiotherapy 2001 11;87(11):573-581 (link here - link correct as at 15/2/22)

National Institute for Health and Care Excellence. Back pain - low (without radiculopathy). 2015; Available at: http://cks.nice.org.uk/back-pain-low-without-radiculopathy. (Accessed 15/2/22)

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE, Clinical Knowledge Summaries [Homepage of NICE], [Online]. Available: http://cks.nice.org.uk/ [15/2/22].