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Low back pain

MedGen UID:
7389
Concept ID:
C0024031
Sign or Symptom
Synonyms: Ache, Low Back; Aches, Low Back; Back Ache, Low; Back Aches, Low; Back Pain, Low; Back Pain, Lower; Back Pains, Low; Back Pains, Lower; Backache, Low; Backaches, Low; Low Back Ache; Low Back Aches; Low Back Pain; Low Back Pains; Low Backache; Low Backaches; Lower Back Pain; Lower Back Pains; Lumbago; Pain, Low Back; Pain, Lower Back; Pains, Low Back; Pains, Lower Back
SNOMED CT: Low back pain (279039007); LBP - Low back pain (279039007); Low back syndrome (279039007); Lumbalgia (279039007); Lumbago (279039007); Lumbar pain (279039007); Nonspecific pain in the lumbar region (279039007)
 
HPO: HP:0003419

Definition

An unpleasant sensation characterized by physical discomfort (such as pricking, throbbing, or aching) localized to the lower back. [from HPO]

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVLow back pain

Conditions with this feature

Alkaptonuria
MedGen UID:
1413
Concept ID:
C0002066
Disease or Syndrome
Alkaptonuria is caused by deficiency of homogentisate 1,2-dioxygenase, an enzyme that converts homogentisic acid (HGA) to maleylacetoacetic acid in the tyrosine degradation pathway. The three major features of alkaptonuria are dark urine or urine that turns dark on standing, ochronosis (bluish-black pigmentation in connective tissue), and arthritis of the spine and larger joints. Ochronosis generally occurs after age 30 years; arthritis often begins in the third decade. Other manifestations can include pigment in the sclera, ear cartilage, and skin of the hands; aortic or mitral valve calcification or regurgitation and occasionally aortic dilatation; renal stones; prostate stones; and hypothyroidism.
Congenital sensory neuropathy with selective loss of small myelinated fibers
MedGen UID:
6916
Concept ID:
C0020075
Disease or Syndrome
Hereditary sensory and autonomic neuropathy type V (HSAN5) is a condition that primarily affects the sensory nerve cells (sensory neurons), which transmit information about sensations such as pain, temperature, and touch. These sensations are impaired in people with HSAN5.\n\nThe signs and symptoms of HSAN5 appear early, usually at birth or during infancy. People with HSAN5 lose the ability to feel pain, heat, and cold. Deep pain perception, the feeling of pain from injuries to bones, ligaments, or muscles, is especially affected in people with HSAN5. Because of the inability to feel deep pain, affected individuals suffer repeated severe injuries such as bone fractures and joint injuries that go unnoticed. Repeated trauma can lead to a condition called Charcot joints, in which the bones and tissue surrounding joints are destroyed.
Werner syndrome
MedGen UID:
12147
Concept ID:
C0043119
Disease or Syndrome
Werner syndrome is characterized by the premature appearance of features associated with normal aging and cancer predisposition. Individuals with Werner syndrome develop normally until the end of the first decade. The first sign is the lack of a growth spurt during the early teen years. Early findings (usually observed in the 20s) include loss and graying of hair, hoarseness, and scleroderma-like skin changes, followed by bilateral ocular cataracts, type 2 diabetes mellitus, hypogonadism, skin ulcers, and osteoporosis in the 30s. Myocardial infarction and cancer are the most common causes of death; the mean age of death in individuals with Werner syndrome is 54 years.
Axial osteosclerosis
MedGen UID:
98482
Concept ID:
C0432264
Disease or Syndrome
Osteomesopyknosis is a nonmalignant sclerosing bone dysplasia of the axial skeleton. Osteosclerosis is limited to the axial skeleton, pelvis, and proximal long bones. The condition is often an incidental radiologic finding in a young adult complaining of back pain. Patients have normal height and laboratory examinations are within normal limits (summary by Yao and Camacho, 2014).
CARASIL syndrome
MedGen UID:
325051
Concept ID:
C1838577
Disease or Syndrome
HTRA1 disorder is a phenotypic spectrum in which some individuals have few to no symptoms and others manifest with the more severe CARASIL (cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy) phenotype. Those who have a heterozygous HTRA1 pathogenic variant may have mild neurologic findings (sometimes identified only on neuroimaging) or mild-to-moderate neurologic signs and symptoms of CARASIL. In this chapter, the term "classic CARASIL" refers to the more severe phenotype associated with biallelic pathogenic variants, and "HTRA1 cerebral small vessel disease" (HTRA1-CSVD) refers to the milder phenotype associated with a heterozygous HTRA1 pathogenic variant. Classic CARASIL is characterized by early-onset changes in the deep white matter of the brain observed on MRI, and associated neurologic findings. The most frequent initial symptom is gait disturbance from spasticity beginning between ages 20 and 40 years. Forty-four percent of affected individuals have stroke-like episodes before age 40 years. Mood changes (apathy and irritability), pseudobulbar palsy, and cognitive dysfunction begin between ages 20 and 50 years. The disease progresses slowly following the onset of neurologic symptoms. Scalp alopecia and acute mid- to lower-back pain (lumbago) before age 30 years are characteristic. The most frequent initial symptom in individuals with HTRA1-CSVD is slowly progressive gait disturbance after age 40 years, which may be followed by the development of mood changes and cognitive dysfunction. A majority of affected individuals have a stroke-like episode after age 40 years. Spondylosis and alopecia are seen in a minority of individuals with HTRA1-CSVD.
Hereditary spastic paraplegia 8
MedGen UID:
400359
Concept ID:
C1863704
Disease or Syndrome
Hereditary spastic paraplegia 8 (SPG8) is a slowly progressive pure spastic paraplegia of the lower limbs (i.e., pyramidal signs including hyperreflexia, spasticity, and occasionally clonus without other neurologic findings). Some affected individuals have urinary urgency that usually becomes apparent at the same time as the spasticity. Onset is between ages ten and 59 years. Affected individuals often become wheelchair dependent. While intra- and interfamilial phenotypic variability is high, SPG8 is typically more severe than other types of hereditary spastic paraplegia.
Hereditary spastic paraplegia 4
MedGen UID:
401097
Concept ID:
C1866855
Disease or Syndrome
Spastic paraplegia 4 (SPG4; also known as SPAST-HSP) is characterized by insidiously progressive bilateral lower-limb gait spasticity. More than 50% of affected individuals have some weakness in the legs and impaired vibration sense at the ankles. Sphincter disturbances are very common. Onset is insidious, mostly in young adulthood, although symptoms may start as early as age one year and as late as age 76 years. Intrafamilial variation is considerable.
Spondylocostal dysostosis 5
MedGen UID:
901825
Concept ID:
C4083048
Disease or Syndrome
Spondylocostal dysostosis (SCDO), defined radiographically as multiple segmentation defects of the vertebrae (M-SDV) in combination with abnormalities of the ribs, is characterized clinically by: a short trunk in proportion to height; short neck; non-progressive mild scoliosis in most affected individuals, and occasionally, more significant scoliosis. Respiratory function in neonates may be compromised by reduced size of the thorax. By age two years lung growth may improve sufficiently to support relatively normal growth and development; however, even then life-threatening complications can occur, especially pulmonary hypertension in children with severely restricted lung capacity from birth. Males with SCDO appear to be at increased risk for inguinal hernia.
Inclusion body myopathy and brain white matter abnormalities
MedGen UID:
1812978
Concept ID:
C5676909
Disease or Syndrome
Inclusion body myopathy and brain white matter abnormalities (IBMWMA) is an autosomal dominant adult-onset disorder characterized predominantly by proximal limb girdle muscle weakness affecting the lower and upper limbs and resulting in gait difficulties and scapular winging. Additional features may include dysarthria, dysphagia, low back pain, and hyporeflexia. EMG is consistent with a myopathic process, although neuropathic findings have also been shown. Muscle biopsy shows fiber type variation, internal nuclei, rimmed vacuoles, and cytoplasmic protein aggregates or inclusions. Serum creatine kinase is usually elevated. Cognitive impairment or frontotemporal dementia occurs in some patients. The disorder is slowly progressive; some patients become wheelchair-bound after many years. Rare patients with this mutation develop ALS; some have both myopathy and ALS. Brain imaging shows white matter abnormalities using diffusion tensor imaging. The disorder is classified as multisystem proteinopathy-6 (MSP6) due to the characteristic disease mechanism of protein misfolding and abnormal tissue deposition (summary by Leoni et al., 2021).

Professional guidelines

PubMed

Corp N, Mansell G, Stynes S, Wynne-Jones G, Morsø L, Hill JC, van der Windt DA
Eur J Pain 2021 Feb;25(2):275-295. Epub 2020 Nov 12 doi: 10.1002/ejp.1679. PMID: 33064878Free PMC Article
Oliveira CB, Maher CG, Pinto RZ, Traeger AC, Lin CC, Chenot JF, van Tulder M, Koes BW
Eur Spine J 2018 Nov;27(11):2791-2803. Epub 2018 Jul 3 doi: 10.1007/s00586-018-5673-2. PMID: 29971708
De La Cruz MS, Buchanan EM
Am Fam Physician 2017 Jan 15;95(2):100-107. PMID: 28084714

Curated

UK NICE Guideline NG59, Low back pain and sciatica in over 16s: assessment and management, 2020

Recent clinical studies

Etiology

Chou R
Ann Intern Med 2021 Aug;174(8):ITC113-ITC128. Epub 2021 Aug 10 doi: 10.7326/AITC202108170. PMID: 34370518
Knezevic NN, Candido KD, Vlaeyen JWS, Van Zundert J, Cohen SP
Lancet 2021 Jul 3;398(10294):78-92. Epub 2021 Jun 8 doi: 10.1016/S0140-6736(21)00733-9. PMID: 34115979
Chenot JF, Greitemann B, Kladny B, Petzke F, Pfingsten M, Schorr SG
Dtsch Arztebl Int 2017 Dec 25;114(51-52):883-890. doi: 10.3238/arztebl.2017.0883. PMID: 29321099Free PMC Article
Maher C, Underwood M, Buchbinder R
Lancet 2017 Feb 18;389(10070):736-747. Epub 2016 Oct 11 doi: 10.1016/S0140-6736(16)30970-9. PMID: 27745712
Patrick N, Emanski E, Knaub MA
Med Clin North Am 2014 Jul;98(4):777-89, xii. doi: 10.1016/j.mcna.2014.03.005. PMID: 24994051

Diagnosis

Knezevic NN, Candido KD, Vlaeyen JWS, Van Zundert J, Cohen SP
Lancet 2021 Jul 3;398(10294):78-92. Epub 2021 Jun 8 doi: 10.1016/S0140-6736(21)00733-9. PMID: 34115979
Urits I, Burshtein A, Sharma M, Testa L, Gold PA, Orhurhu V, Viswanath O, Jones MR, Sidransky MA, Spektor B, Kaye AD
Curr Pain Headache Rep 2019 Mar 11;23(3):23. doi: 10.1007/s11916-019-0757-1. PMID: 30854609
Will JS, Bury DC, Miller JA
Am Fam Physician 2018 Oct 1;98(7):421-428. PMID: 30252425
Maher C, Underwood M, Buchbinder R
Lancet 2017 Feb 18;389(10070):736-747. Epub 2016 Oct 11 doi: 10.1016/S0140-6736(16)30970-9. PMID: 27745712
Delitto A, George SZ, Van Dillen L, Whitman JM, Sowa G, Shekelle P, Denninger TR, Godges JJ; Orthopaedic Section of the American Physical Therapy Association
J Orthop Sports Phys Ther 2012 Apr;42(4):A1-57. Epub 2012 Mar 30 doi: 10.2519/jospt.2012.42.4.A1. PMID: 22466247Free PMC Article

Therapy

Chen Z, Wu J, Wang X, Wu J, Ren Z
Complement Ther Med 2021 Jun;59:102737. Epub 2021 May 10 doi: 10.1016/j.ctim.2021.102737. PMID: 33984499
O'Keeffe M, O'Sullivan P, Purtill H, Bargary N, O'Sullivan K
Br J Sports Med 2020 Jul;54(13):782-789. Epub 2019 Oct 19 doi: 10.1136/bjsports-2019-100780. PMID: 31630089Free PMC Article
Yamato TP, Maher CG, Saragiotto BT, Hancock MJ, Ostelo RW, Cabral CM, Menezes Costa LC, Costa LO
Cochrane Database Syst Rev 2015 Jul 2;2015(7):CD010265. doi: 10.1002/14651858.CD010265.pub2. PMID: 26133923Free PMC Article
Oltean H, Robbins C, van Tulder MW, Berman BM, Bombardier C, Gagnier JJ
Cochrane Database Syst Rev 2014 Dec 23;2014(12):CD004504. doi: 10.1002/14651858.CD004504.pub4. PMID: 25536022Free PMC Article
Rubinstein SM, Terwee CB, Assendelft WJ, de Boer MR, van Tulder MW
Cochrane Database Syst Rev 2012 Sep 12;2012(9):CD008880. doi: 10.1002/14651858.CD008880.pub2. PMID: 22972127Free PMC Article

Prognosis

Wong CK, Mak RY, Kwok TS, Tsang JS, Leung MY, Funabashi M, Macedo LG, Dennett L, Wong AY
J Pain 2022 Apr;23(4):509-534. Epub 2021 Aug 24 doi: 10.1016/j.jpain.2021.07.012. PMID: 34450274
Maselli F, Storari L, Barbari V, Colombi A, Turolla A, Gianola S, Rossettini G, Testa M
BMC Musculoskelet Disord 2020 Jun 3;21(1):343. doi: 10.1186/s12891-020-03357-4. PMID: 32493481Free PMC Article
GBD 2016 Disease and Injury Incidence and Prevalence Collaborators
Lancet 2017 Sep 16;390(10100):1211-1259. doi: 10.1016/S0140-6736(17)32154-2. PMID: 28919117Free PMC Article
Hoy D, Brooks P, Blyth F, Buchbinder R
Best Pract Res Clin Rheumatol 2010 Dec;24(6):769-81. doi: 10.1016/j.berh.2010.10.002. PMID: 21665125
Andersson GB
Lancet 1999 Aug 14;354(9178):581-5. doi: 10.1016/S0140-6736(99)01312-4. PMID: 10470716

Clinical prediction guides

Hoy D, Brooks P, Woolf A, Blyth F, March L, Bain C, Baker P, Smith E, Buchbinder R
J Clin Epidemiol 2012 Sep;65(9):934-9. Epub 2012 Jun 27 doi: 10.1016/j.jclinepi.2011.11.014. PMID: 22742910
Haskins R, Rivett DA, Osmotherly PG
Man Ther 2012 Feb;17(1):9-21. Epub 2011 Jun 8 doi: 10.1016/j.math.2011.05.001. PMID: 21641849
Hicks GE, Fritz JM, Delitto A, McGill SM
Arch Phys Med Rehabil 2005 Sep;86(9):1753-62. doi: 10.1016/j.apmr.2005.03.033. PMID: 16181938
Woby SR, Roach NK, Urmston M, Watson PJ
Pain 2005 Sep;117(1-2):137-44. doi: 10.1016/j.pain.2005.05.029. PMID: 16055269
Laslett M, Aprill CN, McDonald B, Young SB
Man Ther 2005 Aug;10(3):207-18. doi: 10.1016/j.math.2005.01.003. PMID: 16038856

Recent systematic reviews

Hayden JA, Ellis J, Ogilvie R, Stewart SA, Bagg MK, Stanojevic S, Yamato TP, Saragiotto BT
J Physiother 2021 Oct;67(4):252-262. Epub 2021 Sep 16 doi: 10.1016/j.jphys.2021.09.004. PMID: 34538747
Corp N, Mansell G, Stynes S, Wynne-Jones G, Morsø L, Hill JC, van der Windt DA
Eur J Pain 2021 Feb;25(2):275-295. Epub 2020 Nov 12 doi: 10.1002/ejp.1679. PMID: 33064878Free PMC Article
Namnaqani FI, Mashabi AS, Yaseen KM, Alshehri MA
J Musculoskelet Neuronal Interact 2019 Dec 1;19(4):492-499. PMID: 31789300Free PMC Article
Meucci RD, Fassa AG, Faria NM
Rev Saude Publica 2015;49:1. Epub 2015 Oct 20 doi: 10.1590/S0034-8910.2015049005874. PMID: 26487293Free PMC Article
Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, Woolf A, Vos T, Buchbinder R
Arthritis Rheum 2012 Jun;64(6):2028-37. Epub 2012 Jan 9 doi: 10.1002/art.34347. PMID: 22231424

Supplemental Content

Table of contents

    Clinical resources

    Practice guidelines

    • PubMed
      See practice and clinical guidelines in PubMed. The search results may include broader topics and may not capture all published guidelines. See the FAQ for details.
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      See practice and clinical guidelines in NCBI Bookshelf. The search results may include broader topics and may not capture all published guidelines. See the FAQ for details.

    Curated

    • NICE, 2020
      UK NICE Guideline NG59, Low back pain and sciatica in over 16s: assessment and management, 2020

    Consumer resources

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