Prevention and treatment of low back pain: evidence, challenges, and promising directions

Nadine E. Foster, Johannes R. Anema, Dan Cherkin, Roger Chou, Steven P. Cohen, Douglas P. Gross, Paulo H. Ferreira, Julie M. Fritz, Bart W. Koes, Wilco C. Peul, Judith A. Turner, Chris G. Maher, Rachelle Buchbinder, Jan Hartvigsen, Dan Cherkin, Nadine E. Foster, Chris G. Maher, Martin Underwood, Maurits van Tulder, Johannes R. Anema & 24 others Roger Chou, Stephen P. Cohen, Lucíola Menezes Costa, Peter Croft, Manuela Ferreira, Paulo H. Ferreira, Julie M. Fritz, Stéphane Genevay, Douglas P. Gross, Mark J. Hancock, Damian Hoy, Jaro Karppinen, Bart W. Koes, Alice Kongsted, Quinette Louw, Birgitta Öberg, Wilco C. Peul, Glenn Pransky, Mark Schoene, Joachim Sieper, Rob J. Smeets, Judith A. Turner, Anthony Woolf, Lancet Low Back Pain Series Working Group

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Many clinical practice guidelines recommend similar approaches for the assessment and management of low back pain. Recommendations include use of a biopsychosocial framework to guide management with initial non-pharmacological treatment, including education that supports self-management and resumption of normal activities and exercise, and psychological programmes for those with persistent symptoms. Guidelines recommend prudent use of medication, imaging, and surgery. The recommendations are based on trials almost exclusively from high-income countries, focused mainly on treatments rather than on prevention, with limited data for cost-effectiveness. However, globally, gaps between evidence and practice exist, with limited use of recommended first-line treatments and inappropriately high use of imaging, rest, opioids, spinal injections, and surgery. Doing more of the same will not reduce back-related disability or its long-term consequences. The advances with the greatest potential are arguably those that align practice with the evidence, reduce the focus on spinal abnormalities, and ensure promotion of activity and function, including work participation. We have identified effective, promising, or emerging solutions that could offer new directions, but that need greater attention and further research to determine if they are appropriate for large-scale implementation. These potential solutions include focused strategies to implement best practice, the redesign of clinical pathways, integrated health and occupational interventions to reduce work disability, changes in compensation and disability claims policies, and public health and prevention strategies.

Original languageEnglish
Pages (from-to)2368-2383
Number of pages16
JournalThe Lancet
Volume391
Issue number10137
DOIs
Publication statusPublished - 9 Jun 2018

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Low Back Pain
Practice Guidelines
Spinal Injections
Critical Pathways
Occupational Health
Self Care
Opioid Analgesics
Cost-Benefit Analysis
Therapeutics
Public Health
Guidelines
Psychology
Education
Research
Direction compound

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Foster, N. E., Anema, J. R., Cherkin, D., Chou, R., Cohen, S. P., Gross, D. P., ... Lancet Low Back Pain Series Working Group (2018). Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet, 391(10137), 2368-2383. https://doi.org/10.1016/S0140-6736(18)30489-6
Foster, Nadine E. ; Anema, Johannes R. ; Cherkin, Dan ; Chou, Roger ; Cohen, Steven P. ; Gross, Douglas P. ; Ferreira, Paulo H. ; Fritz, Julie M. ; Koes, Bart W. ; Peul, Wilco C. ; Turner, Judith A. ; Maher, Chris G. ; Buchbinder, Rachelle ; Hartvigsen, Jan ; Cherkin, Dan ; Foster, Nadine E. ; Maher, Chris G. ; Underwood, Martin ; van Tulder, Maurits ; Anema, Johannes R. ; Chou, Roger ; Cohen, Stephen P. ; Menezes Costa, Lucíola ; Croft, Peter ; Ferreira, Manuela ; Ferreira, Paulo H. ; Fritz, Julie M. ; Genevay, Stéphane ; Gross, Douglas P. ; Hancock, Mark J. ; Hoy, Damian ; Karppinen, Jaro ; Koes, Bart W. ; Kongsted, Alice ; Louw, Quinette ; Öberg, Birgitta ; Peul, Wilco C. ; Pransky, Glenn ; Schoene, Mark ; Sieper, Joachim ; Smeets, Rob J. ; Turner, Judith A. ; Woolf, Anthony ; Lancet Low Back Pain Series Working Group. / Prevention and treatment of low back pain : evidence, challenges, and promising directions. In: The Lancet. 2018 ; Vol. 391, No. 10137. pp. 2368-2383.
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Foster, NE, Anema, JR, Cherkin, D, Chou, R, Cohen, SP, Gross, DP, Ferreira, PH, Fritz, JM, Koes, BW, Peul, WC, Turner, JA, Maher, CG, Buchbinder, R, Hartvigsen, J, Cherkin, D, Foster, NE, Maher, CG, Underwood, M, van Tulder, M, Anema, JR, Chou, R, Cohen, SP, Menezes Costa, L, Croft, P, Ferreira, M, Ferreira, PH, Fritz, JM, Genevay, S, Gross, DP, Hancock, MJ, Hoy, D, Karppinen, J, Koes, BW, Kongsted, A, Louw, Q, Öberg, B, Peul, WC, Pransky, G, Schoene, M, Sieper, J, Smeets, RJ, Turner, JA, Woolf, A & Lancet Low Back Pain Series Working Group 2018, 'Prevention and treatment of low back pain: evidence, challenges, and promising directions' The Lancet, vol. 391, no. 10137, pp. 2368-2383. https://doi.org/10.1016/S0140-6736(18)30489-6

Prevention and treatment of low back pain : evidence, challenges, and promising directions. / Foster, Nadine E.; Anema, Johannes R.; Cherkin, Dan; Chou, Roger; Cohen, Steven P.; Gross, Douglas P.; Ferreira, Paulo H.; Fritz, Julie M.; Koes, Bart W.; Peul, Wilco C.; Turner, Judith A.; Maher, Chris G.; Buchbinder, Rachelle; Hartvigsen, Jan; Cherkin, Dan; Foster, Nadine E.; Maher, Chris G.; Underwood, Martin; van Tulder, Maurits; Anema, Johannes R.; Chou, Roger; Cohen, Stephen P.; Menezes Costa, Lucíola; Croft, Peter; Ferreira, Manuela; Ferreira, Paulo H.; Fritz, Julie M.; Genevay, Stéphane; Gross, Douglas P.; Hancock, Mark J.; Hoy, Damian; Karppinen, Jaro; Koes, Bart W.; Kongsted, Alice; Louw, Quinette; Öberg, Birgitta; Peul, Wilco C.; Pransky, Glenn; Schoene, Mark; Sieper, Joachim; Smeets, Rob J.; Turner, Judith A.; Woolf, Anthony; Lancet Low Back Pain Series Working Group.

In: The Lancet, Vol. 391, No. 10137, 09.06.2018, p. 2368-2383.

Research output: Contribution to JournalArticleAcademicpeer-review

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AU - Foster, Nadine E.

AU - Anema, Johannes R.

AU - Cherkin, Dan

AU - Chou, Roger

AU - Cohen, Steven P.

AU - Gross, Douglas P.

AU - Ferreira, Paulo H.

AU - Fritz, Julie M.

AU - Koes, Bart W.

AU - Peul, Wilco C.

AU - Turner, Judith A.

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AU - Hartvigsen, Jan

AU - Cherkin, Dan

AU - Foster, Nadine E.

AU - Maher, Chris G.

AU - Underwood, Martin

AU - van Tulder, Maurits

AU - Anema, Johannes R.

AU - Chou, Roger

AU - Cohen, Stephen P.

AU - Menezes Costa, Lucíola

AU - Croft, Peter

AU - Ferreira, Manuela

AU - Ferreira, Paulo H.

AU - Fritz, Julie M.

AU - Genevay, Stéphane

AU - Gross, Douglas P.

AU - Hancock, Mark J.

AU - Hoy, Damian

AU - Karppinen, Jaro

AU - Koes, Bart W.

AU - Kongsted, Alice

AU - Louw, Quinette

AU - Öberg, Birgitta

AU - Peul, Wilco C.

AU - Pransky, Glenn

AU - Schoene, Mark

AU - Sieper, Joachim

AU - Smeets, Rob J.

AU - Turner, Judith A.

AU - Woolf, Anthony

AU - Lancet Low Back Pain Series Working Group

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Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet. 2018 Jun 9;391(10137):2368-2383. https://doi.org/10.1016/S0140-6736(18)30489-6