Prevention and treatment of low back pain: evidence, challenges, and promising directions (Lancet series)

This Lancet series reviewed the global evidence on how low back pain is treated and prevented, and where current practice falls short.

Key messages

• Guidelines agree on a first-line approach: education, self-management, staying active and exercise. Psychological programmes are recommended when symptoms persist.
• Medication, imaging and surgery should be used cautiously.
• In practice, first-line treatments are often underused, while imaging, bed rest, opioids, spinal injections and surgery are often overused.
• Most trials come from high-income countries, and evidence on prevention and cost-effectiveness is limited.

What it means for patients

For most people, the best first steps are to keep moving, build strength and understand the problem, with specialist care added when needed.

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