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New Insights into Chronic Low Back Pain Management

Chronic low back pain is one of the most frequent reasons for medical consultation. It is important to make the correct diagnosis to select the most appropriate treatment in a stepwise approach. In this narrative review, we focus on the clinical examination, the diagnosis, and the conservative treatment of chronic non-specific low back pain. Belgian guidelines for low back pain were used as a basis, followed by a snowball search starting from two articles. Besides that, the Cochrane database was consulted using the following research areas: “multidisciplinary biopsychosocial rehabilitation”, “physical examination of lumbar spine”, and “rehabilitation back pain”. Lastly, we took information from three handbooks. The diagnosis of low back pain starts with a thorough history, including red, yellow, orange, black, and blue flags. Physical, neurological, sensory, and motor testing is performed and complemented with specific tests for low back pain. With a focus on the conservative treatment, pharmacological and non-pharmacological treatments are possible. For CNSLBP, conservative management is advised, starting with reassurance and clear patient education about the condition. While additional treatments, such as manipulation, massage, and acupuncture, can be considered, their effectiveness is not well supported by evidence. Our center emphasizes exercise within a multidisciplinary biopsychosocial rehabilitation program, and although evidence for this approach is limited, we have seen positive outcomes, including improved mobility, strength, and higher return-to-work rates, particularly with the David Spine Concept (DSC).

Source
Custers P, Van de Kelft E, Eeckhaut B, Sabbe W, Hofman A, Debuysscher A et al. Clinical Examination, Diagnosis, and Conservative Treatment of Chronic Low Back Pain: A Narrative Review. Life 2024;14(9):1090.

Clinical Examination, Diagnosis, and Conservative Treatment of Chronic Low Back Pain: A Narrative Review

Objective
To provide a detailed and evidence-based overview of the clinical examination, diagnostic procedures, and conservative treatment options for chronic non-specific low back pain (CNSLBP), focusing on improving patient management and outcomes.

Methods
This narrative review utilised the following approaches:

  1. Consultation of Belgian guidelines for low back pain.
  2. A snowball search based on two foundational articles.
  3. Literature reviews from the Cochrane database using keywords such as “low back pain,” “multidisciplinary biopsychosocial rehabilitation,” “physical examination of lumbar spine,” and “rehabilitation back pain.”
  4. Reference to three authoritative handbooks on physical rehabilitation, sports medicine, and spine surgery.
Outcome
The review emphasised the importance of an accurate and thorough diagnosis to distinguish between specific and non-specific low back pain. Conservative management was recommended, including patient education, reassurance, exercise, and multidisciplinary biopsychosocial rehabilitation. The David Spine Concept (DSC) positively improved mobility, strength, and return-to-work rates. Although evidence for some treatments like manual therapy and acupuncture remains inconclusive, a multidisciplinary approach yielded positive clinical outcomes for CNSLBP patients.