# Talk:Low back pain

Suggest to add the following after the sentence re: exercise therapy being beneficial for CLBP: 
>A recent network-meta analysis identified that exercise therapy including Pilates, stabilisation/motor control and resistance exercises were most effective at reducing pain intensity. Additionally, those including resistance or stablisation/motor control exercises were best for reducing disability, whereas the prescription of resistance or aerobic exercises were most effective for improving mental health.
//REF: Owen PJ, Miller CT, Mundell NL, et al. Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysisBritish Journal of Sports Medicine Published Online First: 30 October 2019. doi: 10.1136/bjsports-2019-100886 
>It may even be beneficial to add the following reference [Tagliaferri SD, Miller CT, Owen PJ, Mitchell UH, Brisby H, Fitzgibbon B, Masse-Alarie H, Van Oosterwijck J & Belavy DL. Domains of chronic low back pain and assessing treatment effectiveness: A clinical perspective. Pain Practice. Accepted: 9 Oct 2019. DOI: 10.1111/papr.12846] given the nice overview it provides regarding the measurement of outcomes beyond just 'pain intensity', which is not always the only concern in this clinical condition that often suffers from multiple comorbid conditions - e.g. CLBP is the leading cause of disability worldwide [REF: Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, et al. Years lived with disability (ylds) for 1160 sequelae of 289 diseases and injuries 1990–2010: A systematic analysis for the global burden of disease study 2010. The Lancet. 2012;380(9859):2163-96]  — Preceding unsigned comment added by 122.110.91.107 (talk) 00:29, 31 December 2019 (UTC) 

Ref says "For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence). (Grade: strong recommendation)"
The evidence is low quality. The strong recommendation is for non pharmacological tx rather than spinal manipulation itself. Doc James (talk · contribs · email) 18:57, 15 May 2017 (UTC)

RECOMMENDATION 1:
Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation). . Taps2386 (talk) 21:03, 15 May 2017 (UTC)'
Nonpharmacological treatment = strong recommendation to include  superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). maybe the sentence should read thus. Taps2386 (talk) 21:07, 15 May 2017 (UTC)

The strong recommendation is for non pharmacological treatment and not spinal manipulation directly.
Thus IMO the wording "A 2017 review recommended spinal manipulation based on low quality evidence." is best Doc James (talk · contribs · email) 21:15, 15 May 2017 (UTC)
You are correct. Great insight.Taps2386 (talk) 21:33, 15 May 2017 (UTC)

doi:10.7326/M16-2367 JFW | T@lk 14:54, 11 January 2018 (UTC)

There has been an update to reference #3; however, I cannot access full text to see if any of the recommendations have changed. Reference #3 is used a few times in the article, so it may be valuable to assess if anything has changed. https://www.ncbi.nlm.nih.gov/pubmed/29971708 2001:56A:75CE:1700:E09A:1211:964E:4AFF (talk) 05:06, 5 August 2018 (UTC)

Yes an update of this https://www.ncbi.nlm.nih.gov/pubmed/20602122 Doc James (talk · contribs · email) 12:35, 5 August 2018 (UTC)

Hello! This is a top importance medical article and is already rated as being really high quality. Could it be further improved with the help of feedback from academic experts? To find out, submit it to the WikiJournal of Medicine. 


### Reasons for submitting
Get feedback from external experts, and recommendations from our academic editors.
Get recognition for your work, in the form of a citable publication (all page contributors will also be clearly acknowledged).


### What we need
An editor who already made substantial contributions to this article, and who is willing follow it through the editorial process, from initial submission to reacting to recommendations. This involves temporarily working on a separate version of this article at Wikiversity.
No fees involved: WikiJournals are both open access and fee-free.


### How to submit
Go through the article to make sure it is as accurate and up to date as possible
Add the article to the Journal article nomination page.
The article will be imported to the WikiJournal preprint server (see process)
When ready to submit, fill in your details in the authorship declaration form.


### Why this article
We are putting this notice on a few of the highest-importance medical articles in Wikipedia. This article was chosen by one of our editors who is motivated to follow it through the process, and thinks it has good chances of being eventually accepted for publication. (Examples: an accepted article, a declined article.)
Of course, spontaneous submissions are also welcome!
T.Shafee(Evo&Evo)talk 11:59, 6 July 2019 (UTC)

Grammar is wrong Hwfr (talk) 19:09, 27 March 2020 (UTC)

Change “completely better” to recovered in first paragraph Jademala (talk) 04:33, 2 April 2021 (UTC)

All set, thanks. ScottishFinnishRadish (talk) 11:25, 2 April 2021 (UTC)

most (around 75%) do not have a specific cause identified, but are thought to be due to muscle strain or injury to ligaments.
'Non-specific lower back pain' is the term given for this condition. (<-ADD THIS LAST SENTENCE AFTER THE PREVIOUS STATEMENT THAT IS ALREADY INCLUDED IN THE WIKI PAGE. Article does not mention the term 'Non-Specific lower back pain', even though it is used heavily in the literature) Luhrsjk (talk) 04:36, 9 April 2021 (UTC)

Luhrsjk Do you have the links? I'll leave it to someone more knowledgable about medicine to add your info, but they'll need the sources when that happens otherwise the request will be closed. Uses x (talk • contribs) 00:44, 10 April 2021 (UTC)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5769319/  — Preceding unsigned comment added by Luhrsjk (talk • contribs) 02:51, 12 April 2021 (UTC) 

 Not done: please provide reliable sources that support the change you want to be made. ScottishFinnishRadish (talk) 13:27, 14 April 2021 (UTC)
Hi team, 
Mentioned a few weeks ago about acknowledging the term 'Non-specific low back pain'. Was asked to provide reliable resources. I linked below a journal article from The Lancet, a peer reviewed journal. As well as a link to Physiopedia for ease of access.
https://www.sciencedirect.com/science/article/pii/S0140673616309709?casa_token=JUNku8t-QG4AAAAA:If2yJckNRYI_vqZ7n5tQaki_YYHF0Qms0bEKfSX9oY0bzG97bQsDdl1C42njKng6Ht1TZYpRT18
https://www.physio-pedia.com/Non_Specific_Low_Back_Pain
Thanks

The hyperlink for list of possible causes is incorrect. Clicking on the link takes you to a differential diagnosis definition wikipedia page and not possible causes for low back pain.
Consider removing the hyperlink all together.
"A full list of possible causes includes many less common conditions.[5] " Pennyloumac (talk) 22:42, 11 April 2021 (UTC)

 Not done: It wikilinks to how medical professionals try and diagnose a disease or issue when the symptoms are shared between many different possible issues. I think the link is pertinent.  ScottishFinnishRadish (talk) 13:30, 14 April 2021 (UTC)

Suggested article improvement # 1 from a 2010 Cochrane Systematic Review:
Existing text: The evidence for chiropractic care [18] and spinal manipulation is mixed.[17][19][20][21]
Suggested text: The evidence for spinal manipulation is mixed, [17][19][20][21] while the evidence for chiropractic care, which usually combines spinal manipulation with other interventions, such as exercise programs, orthotics and and advice lifestyle modifications, suggests that the pain relief experienced from low back pain is not different than achieved by other treatments such as myofascial therapy, massage, and ultrasound.Youhanna1111 (talk) 17:48, 4 January 2022 (UTC)youhanna1111

Hi, I think it would be useful to get more people to review before this change moves forward. The review found that (quote from conclusion) "there is currently no evidence that supports or refutes that these interventions provide a clinically meaningful difference for pain or disability in people with LBP when compared to other interventions". I think that if we include this evidence we should share this and include mention that there is no evidence to determine if this treatment approach is clinically meaningful. In addition, given that this review is already 11 years old, are there other more recent high-quality sources that may be more appropriate as per WP:MEDDATE? I will flag on WP:MED talk to see if we can get others to weigh in.JenOttawa (talk) 03:00, 14 January 2022 (UTC)
would agree with JenOttawa--Ozzie10aaaa (talk) 14:23, 19 January 2022 (UTC)
Hi @Youhanna1111: just flagging you here in case you did not see these replies. Have a great day! JenOttawa (talk) 15:17, 19 January 2022 (UTC)
Thank you @JenOttawa: and @Ozzie10aaaa:. I thought it was important to include this review as it compared combined chiropractic care with other interventions that are commonly recommended for low back pain, such as ultrasound and hot and cold therapy, as might be administered by physical therapists, myofascial therapy and massage as might be administered by massage therapists, and NSAIDs as might be prescribed by a doctor (in the studies reviewed for chronic low back pain). So the conclusion that there is no clinically meaningful difference between these therapies, is important. But I think to state “that there is no evidence to determine if this treatment approach is clinically meaningful” is incorrect. Unfortunately, there is no more current review for combined chiropractic care. There are however more current reviews for spinal manipulation in both acute and chronic low back pain which are already referenced on the page. But these are a more specific intervention.--Youhanna1111 (talk) 16:53, 26 January 2022 (UTC)Youhanna1111
Thanks for the reply! I understand what you are saying and see that the review is comparing 'clinically meaningful differences" to the other interventions, not to no treatment, so this is not the same as saying it is not "clinically meaningful". Rather than compare it to other interventions, an idea to consider could be to first add a sentence sharing the long and short-term effectiveness of these two treatment options for those experiencing low back pain (clinically meanginful changes in a persons pain), along with a high-quality recent secondary source to support the evidence. I am not at all familiar with the literature so these are just ideas! Hopefully others can give some ideas as well. JenOttawa (talk) 18:29, 26 January 2022 (UTC)
@JenOttawa asked editors at Wikipedia talk:WikiProject Medicine to have a look at this; I'm responding to that request.
My first reaction is that this 57-word-long sentence is too long and too difficult to read.   It would be simpler to split it into separate sentences, or even to re-write it completely.  It appears from this that there are several treatments:
Spinal manipulation
Chiropractic care, which usually combines spinal manipulation with other interventions, such as exercise programs, orthotics and and advice about lifestyle modifications,
myofascial therapy,
massage, and
ultrasound
and probably other things, like exercise (both of the "don't take back pain lying down" variety and also structured exercise programs), physical therapy, surgery, and several types of drugs.
I think it makes more sense to list the treatment options, and then to summarize very generally the efficacy, possibly in fairly vague terms.  I believe the general overview for chronic low back pain is that nothing is highly effective, and the better options are all approximately equal in efficacy.  I think it's more important to communicate basic facts like "treatment makes things better, even if it doesn't completely eliminate all pain" or "chronic pain requires long-term treatment" (because exercising for one hour doesn't prevent low back pain for the rest of your life) than to talk about what does or doesn't have evidence. WhatamIdoing (talk) 02:18, 10 February 2022 (UTC)
Thank you @WhatamIdoing & @JenOttawa. I see your suggestions have been implemented very effectively in the Management section in the body of the article, and I’ll try to get the Intro to match that structure in a more concise manner. As for the basic facts that you suggest - I’d be very uncomfortable making such statements as I couldn’t reference them, and it could come across as my opinion. Youhanna1111 (talk) 18:18, 2 June 2022 (UTC)
I agree that we should not include this type of information without citing suitable sources. WhatamIdoing (talk) 02:49, 3 June 2022 (UTC)

Suggested article improvement # 2:
Existing text: Initial management with non-medication based treatments is recommended[2]. NSAIDs are recommended if these are not sufficiently effective. Normal activity should be continued as much as the pain allows. A number of other options are available for those who do not improve with usual treatment. Opioids may be useful if simple pain medications are not enough, but they are not generally recommended due to side effects.
Suggested text: Initial management with non-medication based treatments is recommended[2]. Non-medication based treatments include acupuncture, spinal manipulation, superficial heat and massage for short-term pain (less than 6 weeks), or acupuncture, spinal manipulation, exercise, tai chi, yoga, CBT or mindfulness-basedstress-reduction for long-term pain (more than 12 weeks)[2]. NSAIDs are recommended if these are not sufficiently effective, as are muscle relaxants for short-term pain[2]. Normal activity should be continued as much as the pain allows. Opioids may be useful if other non-medication and medication-based treatments have failed[2], but they are not generally recommended due to side effects.Youhanna1111 (talk) 19:08, 12 January 2022 (UTC)Youhanna1111

Thanks for sharing these. Do you mind sharing the source for ref #2 in your second improvement? [[User:JenOttawa|JenOttawa]
(talk) 02:42, 14 January 2022 (UTC)

Hi @JenOttawa: The sentence and source for ref #2 in the second improvement is exactly the same as the existing text above it. I've fixed it. Sorry for the confusion!Youhanna1111 (talk) 17:12, 26 January 2022 (UTC)Youhanna1111
Is this what the main body of the article says?  It is easy to focus on the intro, but it's better to write the main part of the article first, and then summarize the outcome.
I do appreciate the mention of muscle relaxants and maintaining normal activity.
I'm a little concerned about naming very specific things.  Like:  tai chi helps, but aikido and water aerobics[1] don't?  Yoga helps, but pilates and barre don't?  Why isn't walking or swimming mentioned?
I'm also not sure that acupuncture is a non-medication treatment, since acupuncturists prescribe herbs and nutritional supplements. WhatamIdoing (talk) 02:39, 10 February 2022 (UTC)
Hi @WhatamIdoing & @JenOttawa - as I mentioned above, I agree the body of the article reviews the management options in a very clear manner, so I’ll try to get the intro to reflect these more clearly and concisely. As for the concerns about what specifically works and doesn’t work - I believe I’m limited to systematic reviews for evidence; these reviews do not mention swimming or walking specifically, but do reference exercise more generally and things like Tai Chi and yoga more specifically. Lastly, acupuncture is referenced by medical guidelines and the NIH as a non-pharmacological treatment. If acupuncture is combined with nutritional or herbal medicines, I think it should be cited as combined acupuncture care in the same way that combined chiropractic care has been referenced in the article. The Cochrane reviews and medical guidelines look at acupuncture as a stand alone treatment. Youhanna1111 (talk) 18:32, 2 June 2022 (UTC)
In addition to review articles (both "systematic" and "narrative" reviews are acceptable), you might also see if you can find a recent medical textbook.  If (like 99% of us) you don't own any of them yourself, then sometimes you can find a relevant chapter in Google Books or through a library. WhatamIdoing (talk) 02:52, 3 June 2022 (UTC)
Narrative reviews are not something I’m familiar with - thanks for the lead @WhatamIdoing! Much appreciated! Youhanna1111 (talk) 03:33, 3 June 2022 (UTC)

"Prevention" section states "Medium-firm mattresses are more beneficial for chronic pain than firm mattresses." (with source). Then goes on to state a few sentences later: "There is no quality data that supports medium firm mattresses over firm mattresses." This seems contradictory.
Not qualified to fix it myself. Nsbrown93 (talk) 08:00, 28 November 2022 (UTC)

Could we add a section on how the character "uncle" in the video game "red dead redemption 2" uses lumbago as an excuse to not do labour? It is a meme in the RDR2 community and is somewhat significant enough i think
Cheers JcwDenno (talk) 20:21, 16 May 2023 (UTC)

I heard that there are contradictory evidence about whether weather does or does not impact lumbago (and Arthralgia), and how this worked if it did. In any case, true or not, this is a common conception, so pro and cons should be listed, shouldn't they?
https://pubmed.ncbi.nlm.nih.gov/27492467/
https://rdcu.be/drCjL
2A01:E0A:3A2:F360:BC74:B936:417B:1DF (talk) 06:21, 21 November 2023 (UTC)

The article mentions neither a chair nor an armchair that may be, simply put, *sub-par* for a person.

Example of poorly picked sitting furniture: modern fad of "gaming chairs" that tend to look like RECARO racing seats - as opposed to a proper office chair.
Another example: a poorly chosen one-size-fits-all "ergonomic" chair that's oriented for a 5'-6' people but causes problems for a 6'2" person.
Also, not taking breaks, working for 8 hours *straight* in some burakugaisha for life = stuck in the same pose for 8 hours. The article could use some mentions of such conditions leading to the subject of the article. 81.89.66.133 (talk) 10:55, 25 September 2025 (UTC)