Low back pain: diagnosis, treatment, and prognosis

Low back pain seems to be an integral part of most human lives and cause different degrees of suffering and disability. The exact cause of the pain cannot be identified in most instances. The making of the diagnosis rests mainly on the patient's history, location, and duration of the pain. Different diagnostic tests have not been proven to add much information and even advanced imaging seems not to be able to identify where the pain comes from in the majority of cases. In establishing a working relationship between the patient and the health care provider the physical examination may be valuable. If the specific cause for the pain cannot be found, there cannot be any specific treatment applied. The multitude of different treatments offered to patients must be regarded as pain modulating modalities and not as cures for low back pain. There is no treatment that has been proven to be highly effective. The natural history of low back pain seems in general to be favourable, but of concern is the consequence of long term or permanent disability. Fear avoidance behaviour has been shown to be part of the disabling pathway in chronic low back pain. Cognitive interventions, designed to remove fear and uncertainty, and to give the patient the confidence that the back is robust even if it hurts, seem promising.