Low back pain

Low back pain or lumbago is a common disorder involving the muscles, nerves, and bones of the back, in between the lower edge of the ribs and the lower fold of the buttocks. Pain can vary from a dull constant ache to a sudden sharp feeling. Low back pain may be classified by duration as acute (pain lasting less than 6 weeks), sub-acute (6 to 12 weeks), or chronic (more than 12 weeks). The symptoms of low back pain usually improve within a few weeks from the time they start, with 40–90% of people recovered by six weeks.

In most episodes of low back pain a specific underlying cause is not identified or even looked for: the pain is believed to be due to mechanical problems such as muscle or joint strain. If the pain does not go away with conservative treatment or if it is accompanied by "red flag" symptoms such as unexplained weight loss, fever, or significant problems with feeling or movement, further testing may be needed to look for a serious underlying problem. In most cases, imaging tools such as CT scans are not useful or recommended for low back pain that lasts less than 6 weeks (with no red flags) and carry their own risks. Some low back pain is caused by damaged intervertebral discs, and the straight leg raise test is useful to identify this cause. In those with chronic pain, the pain processing system may malfunction, causing large amounts of pain in response to non-serious events. Chronic non-specific low back pain is a highly prevalent musculoskeletal condition that not only affects the body, but also a person's social and economic status. Chronic non-specific low back pain is affected by psychosocial factors and unhealthy lifestyles and habits, in addition to musculoskeletal issues.

Normal activity should be continued as much as the pain allows. Initial management with non-medication based treatments is recommended. Non–medication based treatments include superficial heat, massage, acupuncture, or spinal manipulation. If these are not sufficiently effective, NSAIDs are recommended. A number of other options are available for those who do not improve with usual treatment. Opioids do not significantly reduce acute or chronic back pain and are not recommended in chronic low back pain due to the lack of benefit and risks of harm. Opioids carry a risk of side effects such as high rate of addiction, accidental overdose and death. Surgery may be beneficial for those with disc-related chronic pain and disability or spinal stenosis. No clear benefit of surgery has been found for other cases of non-specific low back pain. Low back pain often affects mood, which may be improved by counseling or antidepressants. Alternative medicine therapies do not carry enough evidence to recommend them. The evidence for chiropractic care and spinal manipulation is mixed.

Approximately 9–12% of people (632 million) have low back pain at any given point in time, and nearly 25% report having it at some point over any one-month period. About 40% of people have low back pain at some point in their lives, with estimates as high as 80% among people in the developed world. Low back pain is the greatest contributor to lost productivity, absenteeism, disability and early retirement worldwide. Difficulty with low back pain most often begins between 20 and 40 years of age. Women and older people have higher estimated rates of low back pain and also higher disability estimates. Low back pain is more common among people aged between 40 and 80 years, with the overall number of individuals affected expected to increase as the population ages. According to the World Health Organization in 2023, low back pain is the top medical condition world-wide from which the most number of people world-wide can benefit from improved rehabilitation.