Idiopathic low back pain

Lower back pain without sciatica, stenosis or severe spinal deformation (henceforth referred to as idiopathic lower back pain, ILBP) is common and affects people of all ages. It is second only to the common cold as the most common affliction of mankind and is among the leading complaints bringing patients to physicians’ offices.

The goals of management for patients with ILBP are to:
(i) decrease the pain,
(ii) restore mobility,
(iii) hasten recovery so the patient can resume normal daily activities as soon as possible,
(iv) prevent development of a chronic recurrent condition, and
(v) restore and preserve physical and financial independence and comfort.

However, management for patients with ILBP is challenged by the following problems:
(i) most back pain has no recognizable cause;
(ii) an underlying systemic disease is rare;
(iii) most episodes of back pain are unpreventable, and, most importantly,
(iv) few if any treatments have been proven effective for ILBP.

Among those treatments are limited bed rest, exercise, nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (Tylenol), muscle relaxants and opioids (if acetaminophen or NSAIDs do not relieve the pain), chirotherapy, physiotherapy and, ultimately, surgery (in cases of cauda equina syndrome, infections, tumors and fractures compressing the spinal cord, mechanical instability of the back, and, perhaps, intractable pain with a positive straight-leg-raising test and no response to conservative therapy).

However, the analgesic effects of many treatments for non-specific low back pain are small and do not differ in populations with acute or chronic symptoms. Radial shock wave therapy (RSWT) is an alternative to conservative treatment and should be applied before considering surgery.