Medical management of chronic low back pain: efficacy and outcomes.

Webster, Lynn R; Markman, John

OBJECTIVES Chronic low back pain (CLBP) is common and contributes to significant disability and healthcare costs. The mechanism and etiology of CLBP are frequently unclear, and treatment choices vary. MATERIALS AND METHODS The scientific literature, including expert-generated treatment guidelines, was reviewed and evaluated for data regarding CLBP prevalence and predictors and for evidence of outcomes from pharmacologic and nonpharmacologic therapies. RESULTS Evidence is inconclusive as to superior treatments for CLBP. Even therapies with literature support, including cognitive-behavioral therapy, nonsteroidal anti-inflammatory drugs, and opioids administered short term, do not work for every patient, and combination therapies are frequently beneficial. Early intervention with acute pain may stop the progression to chronicity in predisposed patients; however, much acute back pain resolves spontaneously. Predictors of chronicity include continuing poor function, unwillingness to remain active, psychiatric comorbidities, general poor health, and maladaptive coping strategies. Indefinite diagnoses and genetic vulnerabilities are likely factors in variable patient outcomes. CONCLUSIONS Personalized treatment plans should be informed by response to therapies previously tried, the severity and persistence of symptoms, and the availability of specialist expertise.