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An Approach To:

Vol. 19 No. 2 (2021)

Approach to: Lower back pain

December 13, 2020


Between 50 and 80% of adults will experience lower back pain during their life(1). This condition is responsible for a significant portion of emergency room and primary care consultations and it creates a significant burden on the healthcare services and costs. Even if lower back pain causes a significant impact on the quality of life of the patients most causes are benign. This article presents a systematic approach to identifying the cause of lower back pain, summarizes the indications for further workup and presents current evidence for the management of this condition.


  1. Jarvik JG, Deyo RA. Diagnostic evaluation of low back pain with emphasis on imaging. Ann Intern Med [Internet]. 2002 Oct 1 [cited 2021 Mar 9];137(7):586–97. Available from:
  2. Sun JC, Xu T, Chen KF, Qian W, Liu K, Shi JG, et al. Assessment of cauda equina syndrome progression pattern to improve diagnosis. Spine (Phila Pa 1976) [Internet]. 2014 Apr 1 [cited 2021 Mar 9];39(7):596–602. Available from:
  3. Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic Resonance Imaging of the Lumbar Spine in People without Back Pain. N Engl J Med [Internet]. 1994 Jul 14 [cited 2020 Dec 12];331(2):69–73. Available from:
  4. Chou R. Diagnostic Imaging for Low Back Pain: Advice for High-Value Health Care From the American College of Physicians. Ann Intern Med [Internet]. 2011 Feb 1 [cited 2020 Dec 12];154(3):181. Available from:
  5. Nasser MJ. How to approach the problem of low back pain: an overview. J Family Community Med [Internet]. 2005 Jan [cited 2020 Dec 12];12(1):3–9. Available from:
  6. Tripathy S. The role of serum protein electrophoresis in the detection of multiple myeloma: An experience of a corporate hospital. J Clin Diagnostic Res [Internet]. 2012 Nov 15 [cited 2020 Dec 12];6(9):1458–61. Available from: /pmc/articles/PMC3527769/?report=abstract
  7. Atlas SJ, Deyo RA. Evaluating and managing acute low back pain in the primary care setting. J Gen Intern Med [Internet]. 2001 Feb [cited 2020 Dec 12];16(2):120–31. Available from: /pmc/articles/PMC1495170/?report=abstract
  8. Koes BW, Van Tulder MW, Thomas S. Diagnosis and treatment of low back pain [Internet]. Vol. 332, British Medical Journal. BMJ Publishing Group; 2006 [cited 2020 Dec 12]. p. 1430–4. Available from:
  9. van der Gaag WH, Roelofs PDDM, Enthoven WTM, van Tulder MW, Koes BW. Non-steroidal anti-inflammatory drugs for acute low back pain [Internet]. Vol. 2020, Cochrane Database of Systematic Reviews. John Wiley and Sons Ltd; 2020 [cited 2020 Dec 12]. Available from:
  10. Research SB-A for HCP and, Public undefined, 1994 undefined. Acute low back problems in adults. Clinical practice guideline No 14. [Internet]. [cited 2020 Dec 12]; Available from:
  11. van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low-back pain. Cochrane Database Syst Rev [Internet]. 2003 Apr 22 [cited 2020 Dec 12];2017(3). Available from:
  12. Shekelle PG, Adams AH, Chassin MR, Hurwitz EL, Brook RH. Spinal manipulation for low-back pain [Internet]. Vol. 117, Annals of Internal Medicine. American College of Physicians; 1992 [cited 2020 Dec 12]. p. 590–8. Available from:
  13. Coulter ID, Crawford C, Hurwitz EL, Vernon H, Khorsan R, Suttorp Booth M, et al. Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis [Internet]. Vol. 18, Spine Journal. Elsevier Inc.; 2018 [cited 2020 Dec 12]. p. 866–79. Available from:
  14. Garra G, Singer AJ, Leno R, Taira BR, Gupta N, Mathaikutty B, et al. Heat or cold packs for neck and back strain: A randomized controlled trial of efficacy. Acad Emerg Med [Internet]. 2010 [cited 2020 Dec 12];17(5):484–9. Available from:
  15. Van Tulder MW, Gherkin DC, Berman B, Lao L, Koes BW. The effectiveness of acupuncture in the management of acute and chronic low back pain: A systematic review within the framework of the cochrane collaboration back review group [Internet]. Vol. 24, Spine. Spine (Phila Pa 1976); 1999 [cited 2020 Dec 12]. p. 1113–23. Available from:
  16. Carey TS, Garrett J, Jackman A, McLaughlin C, Fryer J, Smucker DR. The Outcomes and Costs of Care for Acute Low Back Pain among Patients Seen by Primary Care Practitioners, Chiropractors, and Orthopedic Surgeons. N Engl J Med [Internet]. 1995 Oct 5 [cited 2020 Dec 12];333(14):913–7. Available from:
  17. Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, et al. A systematic review of the global prevalence of low back pain [Internet]. Vol. 64, Arthritis and Rheumatism. Arthritis Rheum; 2012 [cited 2021 Mar 9]. p. 2028–37. Available from:


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