An Evidence-Based Approach to Low Back Pain in Primary Care

Low back pain (LBP) is a prevalent condition resulting in many office visits and billions of dollars of medical and social costs per year. While there are multiple potential serious causes, a specific diagnosis cannot be made in up to 85% of patients. Approximately 1% of patients have LBP caused by a serious non-mechanical spinal condition, and about 2% have LBP referred from visceral disease. A directed history and physical examination focusing on the "red flags" of LBP identified by the Agency for Healthcare Research and Quality are still very relevant. Psychosocial factors including job dissatisfaction, insufficient social support in the workplace, and psychologic distress are very influential in the development and persistence of LBP. The "yellow flags" of LBP can identify those at risk for chronicity and disability. This review presents the evidence for established evaluation strategies and treatments for acute and chronic LBP, as well as new information on the impact of cognitive behavioral therapy in the management of LBP.