Prevention and treatment of low back pain: evidence, challenges, and promising directions.
By N. Foster, J. Anema, D. Cherkin, R. Chou, Steven P. Cohen, D. Gross, P. Ferreira, J. Fritz, B. Koes, W. Peul and 22 more. The Lancet, 2018
1,862 citations recorded by the source corpus.
Many clinical practice guidelines recommend similar approaches for the assessment and management of low back pain. Recommendations include use of a biopsychosocial framework to guide management with initial non-pharmacological treatment, including education that supports self-management and resumption of normal activities and exercise, and psychological programmes for those with persistent symptoms. Guidelines recommend prudent use of medication, imaging, and surgery. The recommendations are based on trials almost exclusively from high-income countries, focused mainly on treatments rather than on prevention, with limited data for cost-effectiveness. However, globally, gaps between evidence and practice exist, with limited use of recommended first-line treatments and inappropriately high use of imaging, rest, opioids, spinal injections, and surgery. Doing more of the same will not reduce back-related disability or its long-term consequences. The advances with the greatest potential are arguably those that align practice with the evidence, reduce the focus on spinal abnormalities, and ensure promotion of activity and function, including work participation. We have identified effective, promising, or emerging solutions that could offer new directions, but that need greater attention and further research to determine if they are appropriate for large-scale implementation. These potential solutions include focused strategies to implement best practice, the redesign of clinical pathways, integrated health and occupational interventions to reduce work disability, changes in compensation and disability claims policies, and public health and prevention strategies.
Subfields: Economics and Econometrics, Pathology and Forensic Medicine, Pharmacology
View Paper: https://www.semanticscholar.org/paper/7d02177f92191db4d6c5d6d982ab6f2274407597
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Citations in the corpus
- Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017 (2020, background): “Key recommended principles for LBP would be to reduce unnecessary imaging and treatment, support people to be active and stay at work, and to only use medication, imaging, and surgery prudently (33).”