This is the second paper in the 2018 Lancet Low Back Pain Series. It reviews the global evidence for preventing and treating low back pain and summarizes what modern clinical guidelines actually recommend. It then documents the wide gap between that evidence and everyday practice, and points to promising directions to close it.
When you see non-specific low back pain, the default is primary care management: educate, reassure, keep the patient active and at work, and skip early imaging. Reserve imaging for suspected serious pathology or red flags where the result would change what you do. Ordering an MRI for routine back pain just triggers more testing, referrals, and procedures without helping the patient.
This paper reframes the problem: disability keeps rising not because we lack effective treatments, but because practice ignores the evidence. The high-value moves are exercise, biopsychosocial care, and return-to-work support, not opioids, epidurals, or fusion.
For boards, know the specific reversals: paracetamol is out for LBP, pregabalin is ineffective for sciatica, and adding fusion to decompression for stenosis adds cost and harm without benefit. Stratified care (STarT Back) is the model to remember — match treatment intensity to the patient's risk of persistent disabling pain.
This is the second paper in the 2018 Lancet Low Back Pain Series. It reviews the global evidence for preventing and treating low back pain and summarizes what modern clinical guidelines actually recommend. It then documents the wide gap between that evidence and everyday practice, and points to promising directions to close it.
When you see non-specific low back pain, the default is primary care management: educate, reassure, keep the patient active and at work, and skip early imaging. Reserve imaging for suspected serious pathology or red flags where the result would change what you do. Ordering an MRI for routine back pain just triggers more testing, referrals, and procedures without helping the patient.
This paper reframes the problem: disability keeps rising not because we lack effective treatments, but because practice ignores the evidence. The high-value moves are exercise, biopsychosocial care, and return-to-work support, not opioids, epidurals, or fusion.
For boards, know the specific reversals: paracetamol is out for LBP, pregabalin is ineffective for sciatica, and adding fusion to decompression for stenosis adds cost and harm without benefit. Stratified care (STarT Back) is the model to remember — match treatment intensity to the patient's risk of persistent disabling pain.