Non-specific low back pain – what does it exactly mean? A proposed redefinition and classification of the problem
DOI:
https://doi.org/10.15584/ejcem.2017.4.8Keywords:
low back pain, classification, triage, syndromeAbstract
Introduction. Analysis of the medical literature shows that non-specific low back pain is a multifaceted affliction. Determining the unequivocal definition and classification of the ailment could be somewhat difficult. The following review presents a multiplicity of common low back pain nuances. The paper also shows necessity of unification of the definition and clarification, for placing non-specific low back pain among other musculoskeletal disorders.
Aim. The author will attempt to provide the answers to basic questions about non-specific low back pain. In its form, the paper will have similarities to the prospect study with narrative review features. Although the reader should remember that the article is neither a result of expert team efforts nor non-specific low back pain leading authority opinion. Therefore the suggestions should be interpreted with necessary distance and scientific scepticism.
Material and methods. Proper publications were searched in PubMed and EBSCO scientific articles databases, using terms: ‘nonspecific low back pain’ or ‘non-specific low back pain’, ‘definition’, ‘diagnostic triage’, and ‘classification’ in different combinations.
Results. As a result of the review, subtle correction of the current non-specific low back pain definition has been proposed.
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Airaksinen O, Brox JI, Cedraschi C, et al. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15(2):192–300.
Balagué F, Mannion AF, Pellisé F, Cedraschi C. Non-specific low back pain. Lancet. 2012;379:482–491.
Kent P, Keating J. Do primary-care clinicians think that nonspecific low back pain is one condition? Spine. 2004;29:1022–1031.
Key JA. Intervertebral disc lesions are the most common cause of back pain with or without sciatica. Ann Surg. 1945;121:534–555.
Endean A, Palmer KT, Coggon D. Potential of magnetic resonance imaging findings to refine case definition for mechanical low back pain in epidemiological studies: a systematic review. Spine (Phila Pa 1976). 2011;36:160–169.
Brinjikji W, Luetmer PH, Comstock B, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. Am J Neuroradiol. 2015;36:811–816.
Boos N, Hodler J. What help and what confusion can imaging provide? Baillieres Clin Rheum. 1998;12:115–139.
Borenstein DG, O’Mara JW, Boden SD, et al. The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects: a seven-year follow-up study. J Bone Joint Surg. 2001;83-A:1306–1311.
Breslau J, Seidenwurm D. Socioeconomic aspects of spinal imaging: impact of radiological diagnosis on lumbar spine-related disability. Top Magn Reson Imaging. 2001;11:218–223.
Chou R, Fu R, Carrino JA, Deyo RA. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet. 2009;373:463–472.
Webster BS, Bauer AZ, Choi Y, Cifuentes M, Pransky GS. Iatrogenic consequences of early magnetic resonance imaging in acute, work-related, disabling low back pain. Spine (Phila Pa 1976). 2013;38:1939–1946.
Deyo RA. Cascade effects of medical technology. Ann Rev Public Health. 2002;23:23–44.
Webster BS, Choi Y, Bauer AZ, Cifuentes M, Pransky G. The cascade of medical services and associated longitudinal costs due to nonadherent magnetic resonance imaging for low back pain. Spine (Phila Pa 1976). 2014;39:1433–1440.
Ehrlich GE. Low back pain. Bull World Health Organ. 2003;81:671-676.
Hall H, McIntosh G, Boyle C. Effectiveness of a low back pain classification system. Spine J. 2009;9:648–657.
Hall H. Effective spine triage: Patterns of Pain. Ochsner J. 2014;14:88–95.
Frymoyer JW. Back pain and sciatica. N Eng J Med. 1988;318:291–300.
van Tulder M, Becker A, Bekkering T, et al. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J. 2006;15(2):169–191.
Dionne CE, Dunn KM, Croft PR, et al. A consensus approach toward the standardization of back pain definitions for use in prevalence studies. Spine (Phila Pa 1976). 2008;33:95–103.
Waddell G. The back pain revolution. 2nd ed. Edinburgh, Churchill Livingstone;2004.
Waddell G. Subgroups within “nonspecific” low back pain. J Rheumatol. 2005;32:395–396.
Balagué F, Mannion AF, Pellisé F, Cedraschi C. Non-specific low back pain. Lancet. 2012;379:482–491
Burton AK, Balagué F, Cardon G, et al. European guidelines for prevention in low back pain. Eur Spine J. 2006;15(2):136-168.
Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. BMJ. 2006;332:1430–1434.
Deyo RA, Weinstein JN. Low back pain. N Engl J Med. 2001;344:363–370.
Ziembiński Z. Logika praktyczna. Wyd. 26, Warszawa, PWN;2005:52.
Dionne C, Dunn K, Croft P, et al. A consensus approach toward the standardization of back pain definitions for use in prevalence studies. Spine. 2008;33:95–103.
Atkinson JH. Chronic back pain: Searching for causes and cures. J Rheumatol. 2004;31:2323–2325.
Vanharanta H, Sachs BL, Spivey MA, et al. The relationship of pain provocation to lumbar disc deterioration as seen by CT/discography. Spine. 1987;12:295–298.
Videman T, NurminenM. The occurrence of anular tears and their relation to lifetime back pain history: a cadaveric study using barium sulfate discography. Spine. 2004;29:2668–2676.
Feinstein B, Langton JNK, Jameson RM, Schiller F. Experiments on pain referred from deep somatic tissues. J Bone Joint Surg Am. 1954;35:981–987.
Kellgren JH. On the distribution of pain arising from deep somatic structures with charts of segmental pain areas. Clin Sci. 1939;4:35–46.
Fukui S, Ohseto K, Shiotani M, Ohno K, Karasawa H, Naganuma Y. Distribution of referred pain from the lumbar zygapophyseal joints and dorsal rami. Clin J Pain. 1997;13:303–307.
McCall IW, Park WM, O’Brien JP. Induced pain referral from posterior lumbar elements in normal subjects. Spine. 1979;4:441–446.
Mooney V, Robertson J. The facet syndrome. Clin Orthop. 1976;115:149–156.
Kellgren JH. Observations on referred pain arising from muscle. Clin Sci. 1938;3:175–190.
Fortin JD, Dwyer AP, West S, Pier J. Sacroiliac joint: pain referral maps upon applying a new injection/arthrography technique. Part I: Asymptomatic volunteers. Spine. 1994;19:1475–1482.
El Mahdi MA, Latif FYA, Janko M. The spinal nerve root innervation, and a new concept of the clinicopathological interrelations in back pain and sciatica. Neurochirurgia. 1981;24:137–141.
Smyth MJ, Wright V. Sciatica and the intervertebral disc. An experimental study. J Bone Joint Surg Am. 1959;40:1401–1418.
Murphy DR, Hurwitz EL. A theoretical model for the development of a diagnosis-based clinical decision rule for the management of patients with spinal pain. BMC Musculoskelet Disord. 2007;8:75.
Weiss DJ, Conliffe T, Tata N. Low back pain caused by a duodenal ulcer. Arch Phys Med Rehabil. 1998;79:1137–1139.
Troyer MR. Differential diagnosis of endometriosis in a young adult woman with nonspecific low back pain. Phys Ther. 2007;87:801–810.
Ramond A, Bouton C, Richard I, et al. Psychosocial risk factors for chronic low back pain in primary care – a systematic review. Fam Pract. 2011;28:12–21.
Wand BM, O'Connell NE. Chronic non-specific low back pain – sub-groups or a single mechanism? BMC Musculoskelet Disord. 2008;9:11.
Royal College of General Practitioners. Clinical guidelines for the management of acute low back pain. London: Royal College of General Practitioners. 1999.
Koes BW, van Tulder MW, Ostelo R, Burton AK, Waddell G. Clinical Guidelines for the management of low back pain in primary care: an international comparison. Spine. 2001;26:2504–2513.
Rubinstein SM, van Tulder M. A best-evidence review of diagnostic procedures for neck and low back pain. Best Pract Res Clin Rheumatol. 2008;22:471–482.
Bolechowski F. Podstawy ogólnej diagnostyki klinicznej. Warszawa, PZWL;1982:16–17.
Henschke N, Maher CG, Refshauge KM, et al. Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. Arthritis Rheum. 2009;60:3072–3080.
Chou R, Fu R, Carrino JA, Deyo RA. Imaging strategies for low back pain: systematic review and meta-analysis. Lancet. 2009;373:463–472.
Deyo RA, Mirza SK. Clinical practice. Herniated lumbar intervertebral disk. N Engl J Med. 2016;374:1763–1772.
Lurie J, Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ. 2016;352:h6234.
Lin CW, Verwoerd AJ, Maher CG, et al. How is radiating leg pain defined in randomized controlled trials of conservative treatments in primary care? A systematic review. Eur J Pain. 2014;18:455–464.
Hill JC, Konstantinou K, Egbewale BE, et al. Clinical outcomes among low back pain consulters with referred leg pain in primary care. Spine. 2011;36:2168–2175.
Bogduk N. Clinical anatomy of the lumbar spine and sacrum. 4th ed. Amsterdam, Elsevier;2005:183–186.
Bogduk N. On the definitions and physiology of back pain, referred pain, and radicular pain. Pain. 2009;147:17–19.
Inui Y, Doita M, Ouchi K, et al. Clinical and radiologic features of lumbar spinal stenosis and disc herniation with neuropathic bladder. Spine. 2004;29:869–873.
Konstantinou K, Dunn KM, Ogollah R, et al. Characteristics of patients with low back and leg pain seeking treatment in primary care: baseline results from the ATLAS cohort study. BMC Musculoskelet Disord. 2015;16:332.
Kleinig TJ, Brophy BP, Maher CG. Practical neurology - 3: Back pain and leg weakness. Med J Aust. 2011;195:454–457.
Atlas SJ, Delitto A. Spinal stenosis: surgical versus nonsurgical treatment. Clin Orthop Rel Res. 2006;443:198–207.
Matsumoto M, Watanabe K, Tsuji T, et al. Nocturnal leg cramps: a common complaint in patients with lumbar spinal canal stenosis. Spine. 2009;34:189–194.
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