Update on Low Back Pain (LBP)

In case you did not know this, LBP is big. A large percentage of the population will experience it sooner or later; "Low back pain is the fifth most common reason for all physician visits in the United States." Close to 85% of it is non-specific, meaning no one can really figure out what is causing the pain. Thus, there are many efforts to try to bring the positive outcomes associated with LBP into a much higher percentage bracket.

The latest issue of Annals of Internal Medicine has a few articles looking at LBP (open access is great). Very quick guide to interpreting this literature is that: it comes from a journal with a great reputation and is highly peer-reviewed and these studies use a review of current evidence making them higher up on the hierarchy of evidence than most other research.

The first (Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society) attempts to establish guidelines for clinicians who deal with the issue. They are even nice enough to have a summary for patients of the information contained in the article which is an excellent strategy in patient education.

The next article in the issue is looking at nonpharmacologic approaches to treating LBP and finds the following: Therapies with good evidence of moderate efficacy for chronic or subacute low back pain are cognitive-behavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation. For acute low back pain, the only therapy with good evidence of efficacy is superficial heat.

The last one is looking at pharmacological treatments and finds NSAIDs amongst the "useful" group. Startling statistics show that use of these medications leads to more than 100,000 hospitalizations and 16,000 deaths each year in the United States—equaling more deaths than from AIDS and more than four times as many deaths as those from cervical cancer.
The study authors conclude that: "Evidence is insufficient to identify one medication with a clear overall net advantage because of complex tradeoffs between benefits and harms."

The American Pain Society will publish the comprehensive guideline including invasive procedures for low back pain in 2008.