Prevention and treatment of low back pain: evidence, challenges, and promising directions.
Level 5 - mechanism / opinion, no new human data
Narrative review synthesizing clinical practice guidelines, trial evidence, and healthcare implementation gaps.
PubMed 29573872 · doi:10.1016/S0140-6736(18)30489-6
What was done
The authors synthesized international clinical practice guidelines, existing trial evidence, and global evidence-practice gaps related to the assessment, prevention, and management of low back pain, identifying priority areas and systems-level solutions for implementation.
What was found
The abstract reports no quantitative data. It notes that guidelines consistently recommend a biopsychosocial framework with initial non-pharmacological treatments (patient education, self-management, return to normal activities, exercise, and psychological programs for persistent symptoms) and cautious use of imaging, drugs, and surgery. In contrast, global practice displays persistent evidence-practice gaps, with widespread underuse of recommended first-line interventions and overuse of rest, spinal imaging, opioids, spinal injections, and surgical procedures.
Why it matters
This review highlights a profound disconnect between guideline recommendations and actual care delivery, arguing that reducing disability requires restructuring clinical pathways, public health strategies, and policy rather than continuing standard clinical practices.
Limits
The abstract provides no quantitative effect sizes or systematic review methodology. The reviewed evidence base derives almost exclusively from high-income countries, concentrates heavily on treatment rather than prevention, and lacks robust cost-effectiveness data.