Low back pain (LBP) is defined as pain and discomfort, localised below the costal margin and above the inferior gluteal folds, with or without leg pain. Non-specific (common) low back pain is defined as low back pain not attributed to recognisable, known specific pathology (e.g. infection, tumour, osteoporosis, ankylosing spondylitis, fracture, inflammatory process, radicular syndrome or cauda equina syndrome).
Acute low back pain is usually defined as the duration of an episode of low back pain persisting for less than 6 weeks; sub-acute low back pain as low back pain persisting between 6 and 12 weeks; chronic low back pain as low back pain persisting for 12 weeks or more. Whilst this categorisation is convenient for clinical purposes, it is less helpful when considering the matter of prevention, where back pain and its consequences tend to occur in an episodic manner (de Vet et al. 2002).
In this guideline, recommendations concern common low back pain, covering both
episodic and persistent symptoms: recurrent low back pain is defined as a new episode after a symptom-free period, not an exacerbation of persistent low back pain.
The WG considered that, overall, non-specific low back pain is important not so much for its existence as for its consequences. Therefore, this guideline considers the consequences of common low back pain to be a primary concern for prevention. Consequences are important from the perspectives of the individual and of society. They include broad issues such as recurrence (including severity and disability), work loss, care seeking, health-related quality of life, and compensation.
The lifetime prevalence of low back pain is reported as over 70% in industrialised countries (one-year prevalence 15% to 45%, adult incidence 5% per year).. The prevalence rate during school age approaches that seen in adults (Watson et al. 2002; Taimela et al. 1997), increasing from childhood to adolescence (Balague et al. 1999), and peaking between ages 35 and 55 (Andersson 1997). Symptoms, pathology, and radiological appearances are poorly correlated. Pain cannot be attributed to pathology or neurological encroachment in about 85% of people. A role of genetic influence on liability to back pain is suggested from recent research (Hestbaek et al. 2004; MacGregor et al. 2004).
Acute low back pain is usually considered to be self-limiting (recovery rate 90% within 6 weeks) but 2%-7% of people develop chronic pain. Recurrent and chronic back pain is widely acknowledged to account for a substantial proportion of total workers’ absenteeism. About half the days lost from work are accounted for by the 85% of people away from work for short periods (<7>1 month; this is reflected in the social costs of back pain, where some 80% of the health care and social costs are for the 10% with chronic pain and disability (Nachemson et al. 2000).
These statistics, however, tend to be based on the clinically convenient classification of acute and chronic, which does not fully reflect the pattern of back pain among the population. Recent evidence shows that back pain manifests as an untidy pattern of symptomatic periods interspersed with less troublesome periods (Croft et al. 1998; Hestbaek et al. 2003a; de Vet et al. 2002), though for some the symptoms (and associated disability) may become persistent. Around two-thirds of people are likely to experience relapses of pain over 12-months, and around a third are likely to have relapses of work absence (Hestbaek et al. 2003b). These issues present interpretive difficulties when considering prevention, but are considered, as far as is practical, in the formulation of this guideline.
Importantly, for the scope of this guideline, back pain should be seen as an issue for all ages, and all sectors of society: the prevalence in adolescents is similar to adults (Watson et al. 2002), and the prevalence in workers generally does not dramatically differ from non workers (Nachemson et al. 2000). It is important to distinguish between the presence of symptoms, care seeking, work loss, and disability; these have different prevalence rates and are influenced by a varying balance of biological, psychological, and social factors (Burton Page 8 8 1997; Nachemson et al. 2000). For instance, an episode of back pain can occur for no apparent reason or may result from some strenuous event (whether during work or leisure), whilst disability and sick leave are influenced largely by psychosocial factors (Waddell & Burton 2000).
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Acute low back pain is usually defined as the duration of an episode of low back pain persisting for less than 6 weeks; sub-acute low back pain as low back pain persisting between 6 and 12 weeks; chronic low back pain as low back pain persisting for 12 weeks or more. Whilst this categorisation is convenient for clinical purposes, it is less helpful when considering the matter of prevention, where back pain and its consequences tend to occur in an episodic manner (de Vet et al. 2002).
In this guideline, recommendations concern common low back pain, covering both
episodic and persistent symptoms: recurrent low back pain is defined as a new episode after a symptom-free period, not an exacerbation of persistent low back pain.
The WG considered that, overall, non-specific low back pain is important not so much for its existence as for its consequences. Therefore, this guideline considers the consequences of common low back pain to be a primary concern for prevention. Consequences are important from the perspectives of the individual and of society. They include broad issues such as recurrence (including severity and disability), work loss, care seeking, health-related quality of life, and compensation.
The lifetime prevalence of low back pain is reported as over 70% in industrialised countries (one-year prevalence 15% to 45%, adult incidence 5% per year).. The prevalence rate during school age approaches that seen in adults (Watson et al. 2002; Taimela et al. 1997), increasing from childhood to adolescence (Balague et al. 1999), and peaking between ages 35 and 55 (Andersson 1997). Symptoms, pathology, and radiological appearances are poorly correlated. Pain cannot be attributed to pathology or neurological encroachment in about 85% of people. A role of genetic influence on liability to back pain is suggested from recent research (Hestbaek et al. 2004; MacGregor et al. 2004).
Acute low back pain is usually considered to be self-limiting (recovery rate 90% within 6 weeks) but 2%-7% of people develop chronic pain. Recurrent and chronic back pain is widely acknowledged to account for a substantial proportion of total workers’ absenteeism. About half the days lost from work are accounted for by the 85% of people away from work for short periods (<7>1 month; this is reflected in the social costs of back pain, where some 80% of the health care and social costs are for the 10% with chronic pain and disability (Nachemson et al. 2000).
These statistics, however, tend to be based on the clinically convenient classification of acute and chronic, which does not fully reflect the pattern of back pain among the population. Recent evidence shows that back pain manifests as an untidy pattern of symptomatic periods interspersed with less troublesome periods (Croft et al. 1998; Hestbaek et al. 2003a; de Vet et al. 2002), though for some the symptoms (and associated disability) may become persistent. Around two-thirds of people are likely to experience relapses of pain over 12-months, and around a third are likely to have relapses of work absence (Hestbaek et al. 2003b). These issues present interpretive difficulties when considering prevention, but are considered, as far as is practical, in the formulation of this guideline.
Importantly, for the scope of this guideline, back pain should be seen as an issue for all ages, and all sectors of society: the prevalence in adolescents is similar to adults (Watson et al. 2002), and the prevalence in workers generally does not dramatically differ from non workers (Nachemson et al. 2000). It is important to distinguish between the presence of symptoms, care seeking, work loss, and disability; these have different prevalence rates and are influenced by a varying balance of biological, psychological, and social factors (Burton Page 8 8 1997; Nachemson et al. 2000). For instance, an episode of back pain can occur for no apparent reason or may result from some strenuous event (whether during work or leisure), whilst disability and sick leave are influenced largely by psychosocial factors (Waddell & Burton 2000).
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