Between the lines: a discursive analysis of the non-specific low back pain literature

Background: The term nonspecific low back pain (NSLBP) is often ambiguously defined and inconsistently used in scientific literature. Yet, there is limited discussion and reflection on the meaning of the term and how different meanings influence research and clinical practice. Aim: The aim of this study was to critically analyze the meaning of NSLBP in scientific literature and its consequent influence on research and clinical practice. Methodology and methods: Conducting a Foucauldian discourse analysis, we analyzed 24 articles that explicitly discussed the term's meaning. Relevant articles were retrieved through a systematic literature search of six databases, supplemented by snowballing and expert recommendations. Findings: Our analysis identified five distinct discourses analyzing NSLBP: "Biomedical," "Neurocentric," "Rational-Multifactorial," "Complex-Multifactorial," and "NSLBP Otherwise." Conclusion: Each identified discourse was underpinned by unique assumptions that both enable and constrain certain ways of thinking about, researching, and managing NSLBP. Most discourses were individual-centric, guiding a search for causes and solutions within the individual. An exception was the "NSLBP Otherwise Discourse," which enables a more society-centric perspective and encourages alternative views on NSLBP. Given the significant impact of NSLBP and the paucity of substantial breakthroughs in understanding and management, critical reflection on current discourses and their influence on clinical and research practices seem timely. Moreover, considering the present uncertainty surrounding NSLBP, embracing multiplicity could pave the way for a more expansive research agenda.