Low back pain is a very common symptom. It occurs in high-income, middle-income, and
low-income countries and all age groups from children to the elderly population. Globally,
years lived with disability caused by low back pain increased by 54% between 1990
and 2015, mainly because of population increase and ageing, with the biggest increase
seen in low-income and middle-income countries. Low back pain is now the leading cause
of disability worldwide. For nearly all people with low back pain, it is not possible
to identify a specific nociceptive cause. Only a small proportion of people have a
well understood pathological cause-eg, a vertebral fracture, malignancy, or infection.
People with physically demanding jobs, physical and mental comorbidities, smokers,
and obese individuals are at greatest risk of reporting low back pain. Disabling low
back pain is over-represented among people with low socioeconomic status. Most people
with new episodes of low back pain recover quickly; however, recurrence is common
and in a small proportion of people, low back pain becomes persistent and disabling.
Initial high pain intensity, psychological distress, and accompanying pain at multiple
body sites increases the risk of persistent disabling low back pain. Increasing evidence
shows that central pain-modulating mechanisms and pain cognitions have important roles
in the development of persistent disabling low back pain. Cost, health-care use, and
disability from low back pain vary substantially between countries and are influenced
by local culture and social systems, as well as by beliefs about cause and effect.
Disability and costs attributed to low back pain are projected to increase in coming
decades, in particular in low-income and middle-income countries, where health and
other systems are often fragile and not equipped to cope with this growing burden.
Intensified research efforts and global initiatives are clearly needed to address
the burden of low back pain as a public health problem.