Clinical Assessment and Management of Low Back Pain

Low back pain is a leading cause of disability worldwide, encompassing a spectrum from benign, self-limiting discomfort to presentations of serious underlying disease. Clinical assessment begins with a structured history and physical examination aimed at distinguishing non-specific pain, radicular syndromes and red-flag indicators of serious pathology such as fracture, malignancy or infection. Non-specific low back pain accounts for the majority of presentations and is managed initially with advice to remain active, tailored exercise programmes and manual or physiotherapy interventions. Pharmacological treatment may include non-steroidal anti-inflammatory drugs or analgesics, with opioids reserved for short-term relief in selected cases. Psychosocial factors are increasingly recognised as drivers of chronicity and are addressed through cognitive-behavioural strategies and patient education. Imaging and further investigation are guided by clinical findings rather than routine practice, with magnetic resonance imaging reserved for suspected serious pathology or radiculopathy refractory to conservative care. A multidisciplinary approach that integrates rehabilitation, ergonomic counselling and, when necessary, interventional or surgical options underpins optimal outcomes and minimises progression to chronic disability.

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Clinical Assessment and Management of Low Back Pain publication trend

The graph below shows the total number of articles in clinical assessment and management of low back pain across all publications each year (not limited to Nature Index journals).

Technical terms

Red flags: Clinical signs or symptoms suggesting serious underlying disease requiring urgent investigation or referral.

Cauda equina syndrome: A surgical emergency characterised by compression of the cauda equina nerve roots, often presenting with bladder or bowel dysfunction and saddle anaesthesia.

Serious pathology: Underlying conditions such as infection, fracture, neoplasm or inflammatory disease that may manifest as back pain.

Triage: The process of prioritising patients for further investigation, referral or immediate treatment based on clinical assessment.

References

1. Red flags presented in current low back pain guidelines: a review. European Spine Journal (2016).
2. The prevalence of serious pathology in musculoskeletal physiotherapy patients – a nationwide register-based cohort study. Physiotherapy (2021).
3. A Model of Triage of Serious Spinal Pathologies and Therapeutic Options Based on a Delphi Study. Medicina (2023).