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Review
Non-pharmacological treatment of low back pain in primary care
  1. Mary O'Keeffe12
  1. 1 School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
  2. 2 Institute for Musculoskeletal Health, Sydney, New South Wales, Australia
  1. Correspondence to Dr Mary O'Keeffe; mary.okeeffe{at}sydney.edu.au

https://doi.org/10.1136/dtb.2018.000015

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    Key learning points

    • Low back pain (LBP) is the leading cause of disability worldwide and is associated with a significant personal, social and economic burden.

    • The use of often harmful and ineffective treatments (eg, opioids and surgery) represents a major challenge to the safe and appropriate management of non-specific LBP.

    • Greater emphasis is now placed on non-pharmacological treatments.

    • Self-care advice and reassurance should form the mainstay of non-pharmacological treatment for non-specific LBP, but there is a lack of guidance on how best to deliver reassurance in a way that is acceptable to people with LBP.

    • LBP is an unsolved problem and we currently lack truly effective treatments. Effects are often small and short lived and many treatments do not work at all.

    • Honesty about the current lack of a genuine cure for LBP may encourage a greater self-care approach to LBP, and clinicians should be careful not to overexaggerate the benefits of any one treatment.

    Introduction

    Low back pain (LBP) is the leading cause of disability worldwide and is associated with a significant personal, social and economic burden.1–3 Since we are currently unable to identify the cause of the vast majority of LBP, we call it non-specific LBP.1 3 A diagnosis of non-specific LBP is reached after a detailed triage process in which the clinician must rule out specific spinal pathologies (eg, intraspinal abscess, infections, spondyloarthropathy, malignancy, cauda equina syndrome, and vertebral fractures), radicular syndromes (eg, radicular pain, radiculopathy [(weakness, loss of sensation or loss of reflexes associated with a particular nerve root, or a combination of these, with or without radicular pain)], spinal stenosis)) and non-spinal causes of LBP (eg, hip pathology, referred visceral pain, viral syndromes and vascular causes).4

    Management of non-specific LBP commonly focuses on reducing pain and its consequences, including any associated disability.3 The increasing use …

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    Footnotes

    • Correction notice The paper has been amended since it was published Online First. Citation 6 has been added after the sentence: ‘To maximise reassurance, it has also been suggested to perform a timely review of patients to allow clinicians to assess progress towards recovery, or a method of watchful waiting to delay diagnostic imaging’. Reference 13, the first author's name has been corrected.

    • Competing interests None declared. Disclosure of conflicts of interest form(s) are published online as supplementary files.

    • Provenance and peer review Commissioned, externally peer reviewed.