Back pain is extremely common, and low back pain (LBP) in particular causes more disability globally than any other condition.[1] [2] The point prevalence is 7.5% and the lifetime prevalence exceeds 80%.[1] [3] LBP accounts for over 4% of emergency department visits, making it one of the ten most common presenting complaints.[4]
The primary purpose of the initial encounter is to evaluate whether the symptoms suggest a more serious underlying condition.[5] History and exam provides useful information on the pattern of pain (e.g., radicular vs. lumbosacral pain) but rarely identifies a precise anatomical site.[2] Etiologies may be subdivided into mechanical, systemic or referred, with mechanical being far the most common.[6] Most patients with low back pain, with or without sciatica, do not routinely require imaging when presenting in a nonspecialist setting.[7]
A subset of patients develop chronic LBP, defined as symptoms persistent for >12 weeks.[8] Factors found to increase the risk include maladaptive pain coping behaviors, nonorganic signs, functional impairment, poor general health status, sleep disturbance, and psychiatric comorbidities.[9] [10] [11] [12] The clinician should be aware of these risk factors when counseling and treating patients.
