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 Peul, Judith A. Turner, Chris G. Maher, Lancet Low Back Pain Series Working Group

    Research output: Contribution to journalArticlepeer-review

    831 Citations (Scopus)


    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
    Issue number10137
    Publication statusPublished - 9 Jun 2018


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