Low back pain prevalence studies have long used inconsistent definitions, making cross-study comparison unreliable or impossible. This paper used a modified Delphi process with 28 international experts to produce two standardized definitions — minimal and optimal — for use in epidemiologic prevalence research. The goal was not to identify the 'best' definition but to create a common language that enables valid international comparisons.
When a patient asks you whether their back pain is 'chronic,' be careful: the authors of this consensus paper explicitly flag that the term 'chronic low back pain' is equivocal as currently used, with a discrepancy between its theoretical and practical definitions.
For trainees reading spine epidemiology literature, the core lesson is methodologic: heterogeneity in back pain definitions is not a minor nuisance — it can make cross-study comparison impossible.
This paper establishes that a severity threshold is necessary even in a minimal definition. A simple 'any back pain in the past year' question will capture so many trivial episodes that the prevalence figure loses clinical meaning.
The NRS-over-VAS recommendation matters in practice: when designing research or using validated tools, an 11-point NRS is as sensitive as longer scales and performs better across age groups — including elderly patients who struggle with VAS.
These definitions are scoped to prevalence epidemiology, not clinical assessment or treatment trials. Knowing what a tool was designed for is as important as knowing what it measures.
Low back pain prevalence studies have long used inconsistent definitions, making cross-study comparison unreliable or impossible. This paper used a modified Delphi process with 28 international experts to produce two standardized definitions — minimal and optimal — for use in epidemiologic prevalence research. The goal was not to identify the 'best' definition but to create a common language that enables valid international comparisons.
When a patient asks you whether their back pain is 'chronic,' be careful: the authors of this consensus paper explicitly flag that the term 'chronic low back pain' is equivocal as currently used, with a discrepancy between its theoretical and practical definitions.
For trainees reading spine epidemiology literature, the core lesson is methodologic: heterogeneity in back pain definitions is not a minor nuisance — it can make cross-study comparison impossible.
This paper establishes that a severity threshold is necessary even in a minimal definition. A simple 'any back pain in the past year' question will capture so many trivial episodes that the prevalence figure loses clinical meaning.
The NRS-over-VAS recommendation matters in practice: when designing research or using validated tools, an 11-point NRS is as sensitive as longer scales and performs better across age groups — including elderly patients who struggle with VAS.
These definitions are scoped to prevalence epidemiology, not clinical assessment or treatment trials. Knowing what a tool was designed for is as important as knowing what it measures.