w5 Most patients with back pain will have experienced a previous episode, and acute attacks often occur as exacerbations of chronic low back pain. 7 Croft suggests that in many patients low back pain symptoms fluctuate over time. 6 This is also illustrated by the finding that about 90% of patients with low back pain in primary care will have stopped consulting their doctor within three months. In general, the clinical course of an episode of acute low back pain seems favourable, and most pain and related disability will resolve within a couple of weeks. When red flags are not present, the patient is considered as having non-specific low back pain. In clinical practice, the triage is focused on identification of “red flags” (see box 1) as indicators of possible underlying pathology, including nerve root problems. w4 Low back pain is defined as acute when it persists for less than six weeks, subacute between six weeks and three months, and chronic when it lasts longer than three months. In clinical practice as well as in the literature, nonspecific low back pain is usually classified by the duration of the complaints. However, at present no reliable and valid classification system exists for most cases of non-specific low back pain.
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For example, general practitioners may use lumbago, physiotherapists hyperextension, chiropractors or manual therapists facet joint disorder, and orthopaedic surgeons degenerative disc problems. Many healthcare professionals use a variety of diagnostic labels.
The main challenge is the early identification (for example, based on psychosocial risk factors) of patients at risk for chronicity and subsequently preventing the chronicity from occurring
Imaging might be indicated only in patients with red flag conditionsĮvidence mostly favours active compared with passive treatments in acute and chronic low back painĮvidence based guidelines for the management of low back pain are available in many countries, but implementation needs more effort Most episodes of acute low back pain have a favourable prognosis, but recurrences within a year are commonĭiagnostic triage focuses on excluding specific pathology and nerve root pain
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