Chronic Low Back Pain: A Spine Surgeon’s Graveyard

Background: Chronic low back pain (cLBP) is a prevalent and debilitating condition. The World Health Organisation identified it as a major global health concern with the incidence rising by 50% between 1989 and 2019. It is projected that about 843 million people globally will suffer from cLBP by 2050. Despite its prevalence, the pathogenesis of cLBP remains poorly understood and its treatment fragmented. Almost 70% of cases are categorized as non-specific where the pain could likely be arising from dysfunction in ligament, muscles or joints. Degenerative conditions amount to 27% of cases, while non-spinal and sinister causes contribute to a smaller percentage. Psychosocial factors also play a significant role in both the onset and persistence of cLBP. Discussion: The management of cLBP is multifaceted, focussing on non-surgical interventions such as pharmacological treatment, physical therapy, lifestyle modifications and complementary therapies. While non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants provide symptomatic relief, physical and behavioural therapies are crucial in addressing the chronic nature of the condition. Surgical options are reserved for cases with specific patho-anatomic aetiologies such as spondylolisthesis or spinal stenosis. The management of psychosocial aspects through cognitive behavioural therapy (CBT) is pertinent in enhancing patient outcomes. Conclusion: This article provides a comprehensive review of cLBP, encompassing its aetiology, natural history, evaluation and management strategies. The role of multi-disciplinary approach, patient education and lifestyle modification is important in treating this complex condition. By integrating evidence-based practices with individualized care, the clinician can improve quality of life of patients affected by cLBP.