Low Back Pain

About Low Back Pain

Low back pain is the leading cause of disability worldwide, affecting approximately 620 million people globally. It is the number one cause of years lived with disability YLDs worldwide. Most people experience at least one episode of low back pain in their lifetime. Causes include muscle strain, disc herniation, spinal stenosis, spondylolisthesis, osteoarthritis facet joint, and rarely serious conditions including fractures, infection, cancer, or cauda equina syndrome. Most episodes of acute low back pain improve substantially within a few weeks. Red flag features that prompt urgent assessment include bowel or bladder dysfunction, saddle anesthesia, severe trauma, fever, history of cancer, progressive neurological deficits, and age over 50 with new onset pain. For non specific low back pain, imaging is generally not needed in the first 6 weeks. Management emphasizes staying active, physical therapy, and symptom relief such as NSAIDs; some guidelines, including NICE, no longer recommend paracetamol acetaminophen alone. Guidelines generally advise against opioids for chronic low back pain due to limited benefit and significant risks. Cognitive behavioral therapy can help with chronic pain. Spinal manipulation, acupuncture, and massage may provide short term benefit. Surgery is only indicated for specific conditions herniated disc with radiculopathy, spinal stenosis, spondylolisthesis. Loss of bladder or bowel control, numbness around the genitals or buttocks, or weakness in both legs can indicate cauda equina syndrome, which is a medical emergency; call your local emergency number.