More than two-thirds of the population of Germany has complained of back pain (RS; synonyms: Acute dorsalgia; acute dorsolumbalgia; acute sacral pain; acute lumbago; acute lumbalgia; acute lumbalgia with block; acute lumbalgia with facet irritation; acute lumboischialgia; acute recurrent dorsalgia; acute recurrent lumbalgia; acute lumbar syndrome; acute lumbar spine syndrome; acute lumbar spine syndrome with sacroiliac joint block; brachial neuritis; brachial radicular neuropathy; brachial radiculitis a. n.k. ; thoracic spine syndrome; thoracic spine syndrome; chronic dorsalgia; chronic dorsolumbalgia; chronic lumbago; chronic lumbalgia; chronic low back pain; chronic cervical spine-cervical spine syndrome; chronic cervical spine-cervical spine syndrome; chronic lumbar syndrome; chronic lumbar spine syndrome; chronic pseudoradicular lumbar syndrome; chronic recurrent lumbar pain; chronic recurrent lumbar syndrome; dorsago; dorsalgia; dorsalgia with block; dorsolumbalgia; dorsopathy; postural back pain; lumbago; cervical spine-lumbar syndrome; cervical spine-lumbar syndrome with block; cervical spine-lumbar syndrome; iliolumbar syndrome; sacroiliac joint syndrome; sacroiliac joint pain; sacroiliac joint syndrome [ISG syndrome]; infectious sciatica; interscapular; interspinous neuralgia; interspinous irritation; ISG syndrome; ISG syndrome [sacroiliac joint syndrome]; lumbar pain; lumbar spine syndrome; lumbago; lumbar back pain; lumbar vertebral syndrome; lumbalgia; lumbalgia with sacroiliac joint irritation; lumbalgia with facet irritation; lumbar syndrome, chronic; lumbosacralgia; lumbar spine compression syndrome; lumbar spine syndrome; lumbar spine syndrome with sacralization; myalgic back pain; myofasciitis of lumbar region; neck pain a. n.k. ; neck-shoulder-arm syndrome; panniculitis of the sacral region; panniculitis of the neck region; panniculitis of the dorsal region; pseudoradicular lumbar syndrome; pseudoradicular cervical syndrome; reactive dorsolumbalgia; recurrent dorsalgia; recurrent dorsolumbalgia; thoracic spine pain; cervical spine pain; lumbar region pain; Lumbar region pain; static lumbalgia; sternoclavicular syndrome; sternocostal syndrome; thoracic syndrome; thoracolumbalgia; thoracolumbar syndrome; sacral strain; unspecific back pain; vertebral pain; vertebral pain syndrome; vertebral syndrome; spinal pain; spinal pain of the cervical spine; spinal pain of the cervical spine; ICD-10 M54. -: Low back pain; M54.5: Low back pain). Back pain, in the sense of low back pain, is understood as pain in the back area below the costal arch and above the gluteal folds with or without radiation and possible further complaints. In the majority of cases (approx. 80%), nonspecific back pain is present, i.e., there is no definite causal relationship between the complaint, clinical findings, and diagnostic imaging. Causes of non-specific back pain include functional conditions, myofascial and ligamentous pain, etc.. Specific back pain/cruciate pain is present in approximately 20% of cases, i.e., there are clear causes (e.g., inflammation of joints and synchondrosis/cartilaginous connection between two bones, compression of nervous structures; trauma, fractures/bone fractures, tumors, etc.) and correlations with imaging findings. The Sk2 guideline “Specific low back pain” assumes that in the majority of cases a specific cause of low back pain can be found. Low back pain is considered the most common cause of disability in young people under 45 years of age. According to the type of pain, low back pain is classified as follows:
- Lumbago (ICD-10 M54.5) – sudden onset of pain in the lumbar region, lumbago, overuse in the sacral region.
- Lumbar pain – chronic, persistent back pain.
- Sciatica (sciatica syndrome; ICD-10 M54.3) – pain in the area supplied by the sciatic nerve with radiation into the leg (see below “sciatica/lumboischialgia”)
- Lumboischialgia (ICD-10 M54.3) – pain in the lumbar region and the supply area of the sciatic nerve with radiation into the leg(see below “sciatica/lumboischialgia“).
Back pain is classified into three groups over time:
- Acute (new onset with a duration of up to 12 weeks or without recurrence within the last 12 months).
- Intermediate or subacute (occurring on less than half the days of the past six months).
- Chronic (on more than half of the days in the past year).
According to the time course, low back pain is defined as follows according to the National Health Care Guideline:
- Acute low back pain: new onset pain episodes lasting < 6 weeks.
- Subacute low back pain: > 6 and < 12 weeks.
- Chronic / chronic recurrent low back pain: > 12 weeks of pain [for graduation of chronic pain, see “Chronic pain/classification”]
Back pain/cruciate pain is classified according to appearance as follows:
- Uncomplicated low back pain – dorsalgia (back pain) or lumbago (so-called “lumbago”) without radicular radiation or neurological deficits in good general condition.
- Radicular low back pain (also called ischialgia or lumboischialgia) – pain originating from a spinal nerve root, such as ischialgia.
- Complicated low back pain – appearance similar to uncomplicated low back pain or, less commonly, radicular low back pain, but more likely to take a dangerous course (e.g., due to trauma, known tumorous, inflammatory rheumatic disease, immunosuppression (suppression of the body’s own defense system), or osteoporosis (bone loss)); occur in 1% of patients
The discogenic (disc-related) triggered specific back pain can be divided into two subgroups:
- Local back pain discogenically caused – usually triggered by median lying disc prolapse (BSP/disc herniation; breakthrough of the annulus fibrosus/fibrous ring), more rarely by pure protrusion (disc protrusion; partially or completely preserved annulus).
- Radiculopathy (irritation or damage to nerve roots) resulting from disc herniation – BSP with mediolateral (“from the middle toward the side”) or lateral (“to the side”) location; thereby compressing descending fibers or the radices (roots) of spinal nerves
The term “extravertebral” low back pain includes pain in the lumbar spine that is caused by adjacent organs that are not directly part of the bony, muscular, or disco-ligamentous structures of the spine….
Two other morphologic entities-osteoporotic vertebral fractures and sacroiliac joint pathologies-may also be the cause of specific low back pain. Sex Ratio: Women are slightly more likely to be affected by chronic low back pain than men. Frequency peak: The disease occurs predominantly between the 20th to 50th year of life. The prevalence (disease frequency) for chronic back pain is 8-21% (in Germany). The lifetime prevalence (frequency of illness throughout life) is as high as 70-85%. Course and prognosis: Back pain can be acute or chronic. One speaks of acute back pain/cruciate pain if the pain does not last longer than 12 weeks. They are usually harmless and 90% heal spontaneously (on their own) in 6 weeks. In about 19% of spontaneously cured patients, a relapse (recurrence of the disease) occurs within a year. In total, up to 70 % recurrences are assumed. In approximately one in ten cases, patients with acute pain syndromes develop chronic pain. Chronic back pain/cruciate pain is said to occur when the pain – recurrent in the short term or persistent – lasts for more than three months. Only 2-7% of develop chronic pain.In 85%, back pain/cruciate pain cannot be attributed to a specific structural disorder. If the back pain persists for more than three days, a medical evaluation should be made. If the back pain is accompanied by accompanying neurological symptoms (paralysis, tingling, or sensory disturbances of the legs), immediate medical consultation is required.Surgery may be required for radicular and complicated causes (e.g., nucleus pulposus prolapse/herniated disc). Comorbidities (concomitant diseases): Back pain is increasingly associated with osteoarthritis or degenerative joint diseases, cardiovascular (affecting the cardiovascular system) and cerebrovascular (affecting the blood vessels of the brain) diseases. Furthermore, complaints such as migraine, headaches, fatigue, respiratory diseases, depression and anxiety disorders show a positive association with back pain.
