Back pain - causes, diagnosis, treatment

Nachemson A
Record ID 31995000036
Authors' objectives:

To summarise the current scientific knowledge on the causes, diagnosis and treatment of back pain.

Authors' results and conclusions: 80% of Swedes experience back pain at some time in their life and each year 1/3 of all adults in Sweden are affected by this problem. Back pain is the most common reason for sick leave (30% of all sick leave) and early retirement in Sweden. The total cost of back pain is estimated at more than 20 billion SEK per year.
Authors' recommendations: It is important to carefully investigate and document information on patients suffering from back pain to ensure that the problems are not being caused by an injury or organic disease. X-ray or specialised examinations are not necessary during the first two weeks of back pain, unless special illness or injury is suspected. For most patients, it is currently impossible to establish the cause of their back pain. Most current methods of treatment lack a scientific foundation, and some methods have been shown to have no effect, or may even be harmful. Prolonged bed rest or other significant motion restriction may have a harmful effect and, in uncomplicated cases, should be limited to a few days, or two weeks in cases with radiating pain to the lower arm or lower leg. Early mobilisation using controlled exercises shortens the episode, and early return to work results in a lower risk for chronic back pain. Work involving prolonged in certain positions or performing certain activities may cause impairing back problems. New scientific studies indicate that even psychosocial factors, particularly those related to work organisation and work satisfaction are important to both the origin and continuation of back pain. Special information and educational activities about this knowledge should be more comprehensive and should be initiated by the concerned public authorities, employers, trade unions, occupational health programs and general health services. In particular, work environments with a high level of sick leave due to back pain should be studied and improved based on the relationship of psychosocial factors and back pain. To improve rehabilitation for back pain, special activation and functional exercise programs should be offered to those who have been on sick leave for more than three to four weeks. Measures should be taken to reduce the time for the social insurance office to process claims related to occupational injuries associated with back pain. Established practice and new methods for treating back pain should be carefully tested through prospective, randomised and controlled studies. These studies should be multidisciplinary and should include medical, social, psychological, ergonomic and economic components. Other output or dissemination activity: An update report is currently under way.
Authors' methods: Review
Project Status: Completed
Year Published: 1991
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Sweden
MeSH Terms
  • Acupuncture Therapy
  • Back Pain
  • Chiropractic
  • Diskectomy
  • Low Back Pain
  • Occupational Health
  • Rehabilitation
  • Sciatica
  • Spondylolisthesis
  • Transcutaneous Electric Nerve Stimulation
Organisation Name: Swedish Agency for Health Technology Assessment and Assessment of Social Services
Contact Address: P.O. Box 3657, SE-103 59 Stockholm, Sweden. Tel: +46 8 4123200, Fax: +46 8 4113260
Contact Name:
Contact Email:
Copyright: <p>The Swedish Council on Technology Assessment in Health Care</p>
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.