Management of low back pain

#### Summary points Back pain is the leading cause of occupational disability in the world and the most common cause of missed workdays. As the population ages and our lives become more sedentary, this situation is unlikely to change. We aim here to provide an evidence based overview of low back pain aimed at primary care physicians. The most frequently quoted epidemiological studies cite lifetime adult prevalence rates varying from 50% to 80%, and point prevalence rates from 15% to 30%.1 Yet even these statistics may underestimate the problem. A recent prospective study of 154 reserve soldiers with no prior history of back pain found that 64% of this low risk group developed at least moderate back pain over an 18 month period when queried monthly.w1 This suggests that reported prevalence rates may be a function of the type and frequency of surveillance. ### History Box 1 lists the causes of low back pain. The origin of pain can be broadly classified as mechanical, neuropathic, or secondary to another cause. Mechanical back pain implies that the source of pain is in the spine or its supporting structures. Neuropathic back pain denotes the presence of symptoms that stem from irritation of a nerve root(s). #### Box 1 Common causes of low back pain* ##### Mechanical (80-90%)