The estimated lifetime prevalence of low back pain in the United States population is over 80%. Spinal disorders are among the most frequent reasons for adult outpatient visits, 29 and the annual U.S. economic costs attributed to diagnosing and managing low back pain and lost productivity exceed $100 billion. Most patients with acute low back pain get better within 6 weeks; for patients with nonspecific symptoms, clinical guidelines emphasize reassurance, staying active, analgesics, muscle relaxants, and spinal manipulation therapy. Overall, about 10% to 15% of patients with acute low back pain develop chronic symptoms, often associated with long-term disability.

Factors associated with poor outcomes include inappropriate beliefs that low back pain is a serious clinical condition, maladaptive pain-coping behaviors (avoiding work, movement, or other activities for fear of causing back damage), multiple nonorganic physical examination findings, psychiatric disorders, poor general health, high levels of baseline functional impairment, and low work satisfaction. Review the nonorganic physical findings (the Waddell signs). Appropriate treatments for chronic low back pain include treatments for acute low back pain as well as back exercises and behavioral therapy. Opioids should be used cautiously, given their adverse effects and risks for abuse.

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