Evidence-based insights into the transition from acute to chronic non-specific mechanical low back pain

Abstract The transition from acute to chronic non-specific low back pain remains a significant clinical challenge. Despite early interventions, many patients develop persistent symptoms that are refractory to standard care. This review examines the key factors involved in the transition from acute to chronic low back pain. High initial pain levels, early disability, and radiating symptoms forecast poor outcomes. Psychosocial factors, including fear-avoidance, catastrophising, and low self-efficacy, often appear during the subacute stage and can influence recovery expectations and behaviours. Socioeconomic elements, such as occupational strain, claims for compensation, and limited social support, further influence risk, often through reduced access to healthcare and lower health literacy. A dedicated section discusses the biomechanical aspect, emphasising decreased movement variability, impaired proprioception, and altered trunk muscle recruitment. These often-overlooked changes may occur early and reflect maladaptive control strategies rather than mere pain avoidance. Immunologically, increased pro-inflammatory cytokines and decreased anti-inflammatory markers indicate ongoing immune activation, even in subacute cases. Vitamin D deficiency may also contribute to pain sensitisation, although the causal link remains uncertain. Rather than a single cause, the shift to chronicity involves a complex interaction of multiple factors. Early detection and targeted interventions, especially during the subacute phase, could be vital in preventing long-term disability and enhancing outcomes.