Low back pain


Low back pain affects individuals of all ages and is a leading contributor to disease burden worldwide. Despite advancements in assessment and treatment methods, the management of low back pain remains a challenge for researchers and clinicians alike. One reason for the limited success in identifying effective treatments is the large variation in the manifestations, possible causes, precipitating and maintaining factors, course, prognosis and consequences in terms of activity interference and quality of life. However, despite these challenges, steady progress has been achieved in the understanding of back pain, and important steps in the understanding of the psychological and social risk factors, genetics and brain mechanisms of low back pain have been made. These new findings have given impetus to the development of new diagnostic procedures, evidence-based screening methods and more targeted interventions, which underscore the need for a multidisciplinary approach to the management of low back pain that integrates biological, psychological and social aspects.

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Fig. 1: Years lived with disability for low back pain.
Fig. 2: Vertebral anatomy.
Fig. 3: Type 1 Modic changes.
Fig. 4: Changes in brain activity underlying the transition from acute to chronic back pain.
Fig. 5: How expectations shape back pain.
Fig. 6: Management of low back pain.


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J.W.S.V. is supported by the Research Foundation Flanders, Belgium (FWO Vlaanderen: #G001818N and #G071118N), the ‘Asthenes’ long-term structural funding–Methusalem grant by the Flemish Government, Belgium (METH/15/011) and the National Institute for Health and Disability Insurance (NIHDI: #2018-00047). C.G.M. is supported by the National Health and Medical Research Council of Australia (APP1103022, APP1113532 and APP1134856). C.B.M. is supported the Louise and Alan Edwards Foundation. L.D. is supported by the Canadian Excellence Research Chair fund (grant CERC 09).

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Nature Reviews Disease Primers thanks K. Dunn, S. George, C. Leboeuf-Yde and G. L. Moseley, and other anonymous reviewer(s), for their contribution to the peer review of this work.

Author information

Introduction (J.W.S.V. and C.G.M.); Epidemiology (C.G.M. and B.K.); Mechanisms/pathophysiology (J.W.S.V., K.W., C.B.M., L.D. and M.C.B.); Diagnosis, screening and prevention (C.G.M., J.V.Z. and S.J.L.); Management (J.W.S.V., C.G.M., J.V.Z. and S.J.L.); Quality of life (M.G. and J.W.S.V.); Outlook (J.W.S.V. and M.G.); Overview of the Primer (J.W.S.V.).

Correspondence to Johan W. S. Vlaeyen.

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Competing interests

J.W.S.V. is chief investigator or associate investigator on multiple previous and current research grants from Belgium, including the Flemish Government, Research Foundation Flanders (FWO Vlaanderen) and the National Institute for Health and Disability Insurance (NIHDI). He has received travel expenses for speaking at conferences from the professional associations hosting the conferences and has received honoraria for reviewing grants from government grant agencies and honoraria for marking theses from universities. C.G.M. is chief investigator or associate investigator on multiple previous and current research grants from government research agencies from Australia (for example, the National Health and Medical Research Council (NHMRC) of Australia), Brazil (for example, São Paulo Research Foundation (FAPESP)) and the Netherlands (for example, the Netherlands Organisation for Health Research and Development (ZonMW)). For the past 12 years, his salary has been covered by research fellowships from Australia’s NHMRC or the Australian Research Council. His research has also received funding from philanthropic (for example, Arthritis Australia) and government agencies (for example, NSW WorkCover). He has received travel expenses for speaking at conferences from the professional associations hosting the conferences and has received honoraria for talks from professional associations and the industry hosting the talks, honoraria for reviewing grants from government grant agencies and honoraria for marking theses from the relevant university. C.G.M. received supplementary industry funding for two investigator-initiated NHMRC-funded trials. The first trial (PACE) had co-funding from GlaxoSmithKline. Pfizer provided the study medicine for the second trial, PRECISE, at no cost, but provided no other funding. J.V.Z. is a member of the Executive Board of the World Institute of Pain (WIP). M.G. declares that she is bound by confidentiality agreements that prevent her from disclosing her competing interests in this work. S.J.L. is chief investigator or associate investigator on multiple previous and current research grants from Sweden, including Vetenskapsrådet, FORTE, Riksbankensjubileumsfond, REHSAM and Örebro University. He has received travel expenses for speaking at conferences from the professional associations hosting the conferences and has received honoraria for reviewing grants and giving educational lectures. All other authors declare no competing interests.

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Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ): https://www.oru.se/english/research/research-environments/hs/champ/questionnaires/

STarTBack Screening Tool: https://www.keele.ac.uk/sbst/startbacktool/

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Vlaeyen, J.W.S., Maher, C.G., Wiech, K. et al. Low back pain. Nat Rev Dis Primers 4, 52 (2018) doi:10.1038/s41572-018-0052-1

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