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Review
. 2024 Jun 27;14(7):812.
doi: 10.3390/life14070812.

Chronic Low Back Pain: History, Symptoms, Pain Mechanisms, and Treatment

Tyler Farley  1 , Jesse Stokke  1 , Kush Goyal  1 , Russell DeMicco  1
Affiliations
Review

Chronic Low Back Pain: History, Symptoms, Pain Mechanisms, and Treatment

Tyler Farley et al. Life (Basel). .

Abstract

Chronic low back pain (cLBP) is the most frequently reported cause of years lived with disability. Identifying the anatomical structures or dysfunction contributing to patients' symptoms is critical to guiding treatment. The etiology of back pain and differential diagnosis is often broad, ranging from non-degenerative cLBP (trauma, tumor, inflammation, infection, etc.) to degenerative (also described as nonspecific) cLBP. After eliminating suspicion for more insidious causes of cLBP, a thorough investigation can be conducted in an attempt to identify a source of degenerative cLBP. Degenerative cLBP can originate from many sources, and a detailed understanding of the structures potentially involved is invaluable for an accurate diagnosis. This review article aims to provide a broad overview of the utility of clinical history, physical exam findings, imaging findings, and diagnostic procedures in identifying the cause of patients' cLBP. We provide a framework to help guide clinicians by dividing the structures into groups as follows: anterior vertebral column, posterior vertebral column, and extra-vertebral pain. For each condition listed, we touch on the treatment options that can be considered.

Keywords: axial low back pain; chronic low back pain; discogenic low back pain; lumbar facet arthropathy; lumbar pain; lumbosacral degenerative disease; mechanical low back pain; sacroiliac joint; vertebrogenic low back pain.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
This diagram illustrates the dual innervation of the lumbar facet joints. The L4–L5 joint is receiving innervation from the L3 and L4 medial branches, while the L5-S1 joint is receiving innervation from the L4 medial branch and L5 dorsal ramus proper (prior to dividing to the L5 medial branch). Abbreviations: NR—nerve root; MB—medial branch; FJ—facet joint.
Figure 2
Figure 2
The algorithm depicting a typical treatment protocol for facet joint pain with the goal of radiofrequency ablation after the likelihood of diagnosis increased by two dual diagnostic blocks.
See this image and copyright information in PMC

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