title: Common questions about chronic low back pain.
abstract: More than 30% of U.S. adults report having experienced low back pain within the preceding three months. Although most low back pain is nonspecific and self-limiting, a subset of patients develop chronic low back pain, defined as persistent symptoms for longer than three months. Low back pain is categorized as nonspecific low back pain without radiculopathy, low back pain with radicular symptoms, or secondary low back pain with a spinal cause. Imaging should be reserved for patients with red flags for cauda equina syndrome, recent trauma, risk of infection, or when warranted before treatment (e.g., surgical, interventional). Prompt recognition of cauda equina syndrome is critical. Patient education should be combined with evidence-guided pharmacologic therapy. Goals of therapy include reducing the severity of pain symptoms, pain interference, and disability, as well as maximizing activity. Validated tools such as the Oswestry Disability Index can help assess symptom severity and functional change in patients with chronic low back pain. Epidural steroid injections do not improve pain or disability in patients with spinal stenosis. Spinal manipulation therapy produces small benefits for up to six months. Because long-term data are lacking for spinal surgery, patient education about realistic outcome expectations is essential.
authors.affiliation: Southern Illinois University Edwardsville, Edwardsville, IL, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Herndon
authors.affiliation: Saint Louis University School of Medicine, St. Louis, MO, USA.
authors.forename: Kimberly Schiel
authors.initials: KS
authors.lastname: Zoberi
authors.affiliation: Saint Louis University Family Medicine Residency Program, Belleville, IL, USA.
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Gardner
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D059350:Chronic Pain; D003937:Diagnosis, Differential; D004185:Disability Evaluation; D019468:Disease Management; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D020393:Manipulation, Spinal / Q000379:methods*; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement / Q000379:methods; D010353:Patient Education as Topic; D011128:Polyradiculopathy / Q000150:complications / Q000175:diagnosis; D013130:Spinal Stenosis / Q000150:complications / Q000175:diagnosis
chemical_list: D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000928:Antidepressive Agents