Non-specific low back pain

Lumbago (dolor lumbalis nonspecificus) · Nespecifická bolest dolní části zad

What it is

The leading cause of disability worldwide — and imaging usually shows nothing useful.

call 112 / 911 now Numb groin or buttocks, or losing control of bladder or bowel
call 112 / 911 now Weakness in both legs, or legs giving way
see a doctor soon Back pain with fever, or after cancer
see a doctor soon Constant night pain, or weight loss you can't explain

Stay active — bed rest makes it worse trials support
NSAIDs short-term — small average benefit over placebo mixed evidence
Physiotherapy — modest, and mostly early on mixed evidence
No early imaging: scans show wear in most pain-free adults and lead to surgery that does not help trials support
Opioids for chronic back pain — no better than NSAIDs in trials, with dependence on top not confirmed in trials
CBT when it persists trials support
Basivertebral nerve ablation (Intracept) — FDA-cleared for chronic vertebrogenic back pain

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

Spinal manipulation — trials show effects similar to other recommended treatments trials support
Acupuncture — trials disagree; modest benefit mixed evidence
Devil's claw and willow bark — trials show short-term relief mixed evidence
Inversion tables — little evidence early / small studies
Magnets — trials found no effect not confirmed in trials