Key Points Demographic
ÎLow back pain (LBP) is the fifth most common reason for all physician visits in the United States.
ÎApproximately 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.
ÎTotal incremental direct health care costs attributable to LBP in the U.S. were estimated at $26.3 billion in 1998.
ÎApproximately 5% of the people with back pain disability account for 75% of the costs associated with LBP.
Clinical Recommendations
ÎClinicians 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).
ÎClinicians should NOT routinely obtain imaging or other diagnostic tests in patients with nonspecific LBP (strong recommendation, moderate quality evidence).
ÎClinicians 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).
