The 2018 Lancet Low Back Pain Series

A recent review of three papers in Lancet from 2018 (free at summarizes and updates the findings from these land mark publications. The Lancet papers highlight the magnitude of the global problem of low back pain. The information and issues presented in these papers are ones that IH clinicians and therapists should be aware of when talking to patients about back pain and treatment options, some of which have good clinical evidence and some that do not.

Low back pain is the number one cause of disability in the world. It affects women and men in all age groups from high, middle and low income countries. Despite its prevalence, most low back pain does not have an identifiable cause.

Many patients with low back pain get the wrong kind of treatment. Low value care for low back pain is rampant. ER visits, inappropriate imaging, spinal injections, and surgery all lead to increasing costs but without equivalent benefit. Most international clinical practice guidelines are moving away from medicalized management in favor of early activation, avoiding bed rest, spinal manipulation and simple analgesics. Yet despite this evidence, pharmacologic treatments continue to be first line approaches with opioids being the most troublesome. Newer medical interventions like cannabinoids and regenerative therapies such as platelet-rich plasma injections have been increasingly prescribed despite a lack of evidence of their efficacy.

The low-tech, high-touch interventions at the hands of IH clinicians are at the front lines of addressing the global problem of low back pain.