Key Points
Demographic
ÎÎLow back pain (LBP) is the fifth most common reason for all
physician visits in the United States.
ÎÎApproximately 25% of U.S. adults reported having LBP
lasting at least 1 whole day in the past 3 months, and 7.6%
reported at least 1 episode of severe acute LBP within a
1-year period.
ÎÎTotal incremental direct health care costs attributable to
LBP in the U.S. were estimated at $26.3 billion in 1998.
ÎÎApproximately 5% of the people with back pain disability
account for 75% of the costs associated with LBP.
Clinical Recommendations
ÎÎClinicians should conduct a focused history and physical
examination to help place patients with LBP into 1 of 3
broad categories: nonspecific LBP, back pain potentially
associated with radiculopathy or spinal stenosis, or
back pain potentially associated with another specific
spinal cause. The history should include assessment of
psychosocial risk factors, which predict risk for chronic
disabling back pain (strong recommendation, moderate
quality evidence).
ÎÎClinicians should NOT routinely obtain imaging or other
diagnostic tests in patients with nonspecific LBP (strong
recommendation, moderate quality evidence).
ÎÎClinicians should perform diagnostic imaging and testing
for patients with LBP when severe or progressive neurologic
deficits are present or when serious underlying conditions
are suspected on the basis of history and physical
examination (strong recommendation, moderate quality
evidence).
