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Papers of the Week

2019 Dec 01

Am Fam Physician



Nonspecific Low Back Pain and Return To Work.


Becker BA, Childress MA
Am Fam Physician. 2019 Dec 01; 100(11):697-703.
PMID: 31790184.


Nonspecific low back pain refers to a condition without a distinct etiology to explain its associated symptoms. This pain may become chronic and is a major cause of work loss around the world. Without a specific explanation for a patient's symptoms, the family physician is charged with providing reassurance, while also guiding the patient toward a return to function, which often includes maintaining employment. Evaluating for red flag signs and symptoms helps to eliminate concerning causes of low back pain, such as malignancy, fracture, infection, and cauda equina. Prescribing physical activity, including core strengthening, physical therapy, or yoga, is an important therapeutic intervention. Early return to work should be encouraged when appropriate. There is limited evidence to support workplace modification, medication, or steroid injection for nonspecific low back pain. Early assessment for barriers to recovery, such as fear avoidance beliefs and psychosocial factors, is helpful. Stress management counseling may also be beneficial. Disability guidelines can serve as guideposts for return to work recommendations.