Low Back Pain

Abstract We need a better approach to patients with low back pain (LBP). Current care is plagued by variability, over-medicalization of biopsychosocial problems, inequity, and an overemphasis on interventional and surgical care. Guidelines focused on the short-term management of acute LBP are generally not followed and have limited applicability in clinical care. The reality is that LBP is a chronic recurrent problem for most individuals. Care should therefore be directed toward long-term management and optimization of life and function. Importantly for this book, all LBP conditions are also not created equally. “Low back pain” is a symptom, not a diagnosis, and is analogous to symptoms like shortness of breath and abdominal pain. There are many specific conditions that can be related to or causal of LBP, and there are a numerous comorbidities and patient-specific concerns that influence care. As examples, disc herniations, spinal stenosis, spondylolisthesis, and scoliosis are all common imaging findings that may or may not be causing pain. When symptomatic, the treatment of all is different, and failing to ascertain their significance leads to inappropriate care and unnecessary suffering. LBP in patients with mental health issues, frailty, or chronic pain requires a different approach to similar symptoms in those without these concerns. Nonspecific and poorly verified diagnoses often confound treatment. The cases in this book reflect common clinical presentations. They provide clarity on specific conditions, explore the effects of inequity, take a critical approach to treatment, and offer practical information on effective front-line care for those with LBP.