Multidisciplinary expert consensus on clinical diagnosis and therapies for low back pain

Low back pain (LBP) is one of the most frequently encountered conditions in orthopedics, physical therapy and rehabilitation, and pain medicine. Its etiology is multifactorial and its management options are diverse. However, a unified, standardized, and evidence-based clinical pathway for LBP remains lacking, leading to substantial variation in diagnostic reasoning, treatment selection, outcome assessment, and long-term care across healthcare settings and professional disciplines. To address this gap, Chinese Society for the Study of the Lumbar Spine, Chinese Association of Spine initiated this multidisciplinary expert consensus. The project was organized and implemented by Xijing Hospital of Fourth Military Medical University and Beijing Chaoyang Hospital of Capital Medical University, in collaboration with a national multicenter panel of clinical experts and methodologists. Using rigorous evidence-based methodology, the panel developed an expert consensus on recommendation levels for clinical diagnosis and treatment pathways in LBP. Comprehensive searches of multiple databases and guideline sources were performed from 1991 to December 2025 in this consensus. A total of 4 703 publications were initially retrieved, and 653 publications were ultimately selected to inform the development of the consensus statements, including 70 systematic reviews and 145 original studies that directly supported the formulation and grading of recommendations. Centered on key elements across the entire care continuum, including precise diagnostic assessment, stepwise treatment selection, multimodal comprehensive interventions, long-term outcome management, recurrence prevention, patient education, and self-management, this consensus provides a structured set of recommendations. It clarifies the core diagnostic criteria and intervention strategies for patients with low back pain caused by different etiologies, and classifies interventions as "strong recommendation", "weak recommendation", "weak recommendation against", or "strong recommendation against". The recommendations emphasize individualized and stepwise decision-making tailored to patient-specific circumstances, reaffirm the foundational role of conservative management, and define strict indications for surgery and other invasive interventions. In addition, the consensus evaluates the potential synergistic effects of combined treatment strategies and highlights the importance of recurrence prevention and functional rehabilitation in long-term care. It also provides guidance on multidisciplinary collaboration and referral criteria within the clinical pathway. Overall, this consensus aims to provide clinicians at all levels of healthcare with a clear and authoritative decision-making framework. By promoting a shift from experience-based and fragmented practice toward systematic, standardized, and evidence-based management, this consensus is expected to improve clinical outcomes, enhance patients' quality of life, and support more efficient use and distribution of healthcare resources.

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Publication Details

Journal
Bone Research
Published
2026-08-27
DOI
https://doi.org/10.1038/s41413-026-00572-y
Primary Topic
Musculoskeletal pain and rehabilitation
Type
article
Field-Weighted Citation Impact
0.00

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article

Multidisciplinary expert consensus on clinical diagnosis and therapies for low back pain

Yuzeng Liu, Qian Bangping, Jinghui Huang, Jianguang Xu et al.
Bone Research
Musculoskeletal pain and rehabilitation
article

Multidisciplinary expert consensus on clinical diagnosis and therapies for low back pain

Yuzeng Liu, Qian Bangping, Jinghui Huang, Jianguang Xu, Longxi Ren, Yong Hai, Chunyang Xi, Xun Tang, Yueming Song, Guanyi Wang, Wenzhi Zhang, Jianyuan Jiang, Bo Gao, RunDong Chai, J Z Chen, 邓树才, 陈德玉, Zhaomin Zheng, Zhengxu Ye, J. Xiao, Zhongshi Li, Feizhou Lv, 吴增晖, Baoge Liu, Tao Guo, Xu Huazi, Ye Tian, Huiqiang Ding, Han Jiang, Zengming Xiao, Shaoqian Cui, Yongchao Wu, Shisheng He, Yi Hong, Xu Cao, Qun Yang, Qun Xia, Shiqing Feng, Dike Ruan, Qiang Zhang, Bohua Chen, Huan Wang, Yong Shen, Qing He, Jinglong Yan, Huilin Yang, Lin Nie, Yanzheng Gao, Congren Huang, Huadong Wang, Guoyong Yin, Yu Liang, Hongjian Liu, Chunde Li, Zhenghua Hong, Baogan Peng, Zhiming Sun, Guiyou Feng, Qixin Chen, Zili Wang, Zhibin Meng, Peng Wang, Jun Ao, Weibin Sheng, Zhaoqing Guo, Fang Li, Liang Chen, Bo Li, Qiang Qi, Baorong He, Zhongqiang Chen, Zhuojing Luo, Ji Wu, Zhe Wang, Xuexiao Ma, Shibao Lu, Zengwu Shao, Yang Liu, Cailiang Shen, Wenwen Wu, Yanfang Song, Dianming Jiang, Yong Hai, Li Li, Fangcai Li, Jianzhong Xu, Yunbing Chang, Lei Shang, Bo Liu, Changtai Sun, Haiqing Mao, Hao Liu, Jiangang Shi, Feng Li, Feng Wang, Wei Mei, Ming Li, Haiying Liu
article en

Abstract

Low back pain (LBP) is one of the most frequently encountered conditions in orthopedics, physical therapy and rehabilitation, and pain medicine. Its etiology is multifactorial and its management options are diverse. However, a unified, standardized, and evidence-based clinical pathway for LBP remains lacking, leading to substantial variation in diagnostic reasoning, treatment selection, outcome assessment, and long-term care across healthcare settings and professional disciplines. To address this gap, Chinese Society for the Study of the Lumbar Spine, Chinese Association of Spine initiated this multidisciplinary expert consensus. The project was organized and implemented by Xijing Hospital of Fourth Military Medical University and Beijing Chaoyang Hospital of Capital Medical University, in collaboration with a national multicenter panel of clinical experts and methodologists. Using rigorous evidence-based methodology, the panel developed an expert consensus on recommendation levels for clinical diagnosis and treatment pathways in LBP. Comprehensive searches of multiple databases and guideline sources were performed from 1991 to December 2025 in this consensus. A total of 4 703 publications were initially retrieved, and 653 publications were ultimately selected to inform the development of the consensus statements, including 70 systematic reviews and 145 original studies that directly supported the formulation and grading of recommendations. Centered on key elements across the entire care continuum, including precise diagnostic assessment, stepwise treatment selection, multimodal comprehensive interventions, long-term outcome management, recurrence prevention, patient education, and self-management, this consensus provides a structured set of recommendations. It clarifies the core diagnostic criteria and intervention strategies for patients with low back pain caused by different etiologies, and classifies interventions as "strong recommendation", "weak recommendation", "weak recommendation against", or "strong recommendation against". The recommendations emphasize individualized and stepwise decision-making tailored to patient-specific circumstances, reaffirm the foundational role of conservative management, and define strict indications for surgery and other invasive interventions. In addition, the consensus evaluates the potential synergistic effects of combined treatment strategies and highlights the importance of recurrence prevention and functional rehabilitation in long-term care. It also provides guidance on multidisciplinary collaboration and referral criteria within the clinical pathway. Overall, this consensus aims to provide clinicians at all levels of healthcare with a clear and authoritative decision-making framework. By promoting a shift from experience-based and fragmented practice toward systematic, standardized, and evidence-based management, this consensus is expected to improve clinical outcomes, enhance patients' quality of life, and support more efficient use and distribution of healthcare resources.

Bone ResearchVol. 14(1)
Qingdao University (CN), Hebei Medical University (CN), Union Hospital (HK), Johns Hopkins University (US), Army Medical University (CN), Xinjiang Medical University (CN), Harbin Medical University (CN), Sun Yat-sen University (CN), Second Military Medical University (CN), Zunyi Medical University (CN), Shanghai Jiao Tong University (CN), Capital Medical University (CN), Dalian Medical University (CN), Anhui Medical University (CN), Chinese Academy of Medical Sciences & Peking Union Medical College (CN), Peking University (CN), Sichuan University (CN), Fudan University (CN), Wenzhou Medical University (CN), Guangdong General Hospital (CN), Johns Hopkins Medicine (US), Beijing Chao-Yang Hospital, Capital Medical University (CN), China-Japan Friendship Hospital (CN), Peking Union Medical College Hospital (CN), Ruijin Hospital (CN), China Rehabilitation Research Center (CN), Tianjin Medical University General Hospital (CN), Alice Ho Miu Ling Nethersole Hospital (CN), First Affiliated Hospital of Xinjiang Medical University (CN), Chinese PLA General Hospital (CN), Beijing Jishuitan Hospital (CN), Chinese General Hospital College of Nursing and Liberal Arts (PH), Zhengzhou University (CN), Soochow University (CN), Beijing Tian Tan Hospital (CN), The Fourth People's Hospital (CN), Third Hospital of Hebei Medical University (CN), Tianjin Third Central Hospital (CN), West China Hospital of Sichuan University (CN), Sun Yat-sen Memorial Hospital (CN), Xi'an Honghui Hospital (CN), Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University (CN), Shanghai Changzheng Hospital (CN), Tianjin Huanhu Hospital (CN), Nanfang Hospital (CN), Zhengzhou City Hospital (CN), Nanjing Drum Tower Hospital (CN), Logistics University of People's Armed Police Force (CN), Kunming General Hospital of Chengdu Military Command (CN), Affiliated Hospital of Qingdao University (CN), The Military General Hospital of Beijing PLA (CN), Peking University People's Hospital (CN), First Affiliated Hospital of GuangXi Medical University (CN), Ningxia Medical University (CN), The First Affiliated Hospital, Sun Yat-sen University (CN), The Affiliated Yongchuan Hospital of Chongqing Medical University (CN), Peking University First Hospital (CN), Southwest Hospital (CN), First Affiliated Hospital of Chinese PLA General Hospital (CN), Shanghai Tenth People's Hospital (CN), Second Affiliated Hospital of Harbin Medical University (CN), Henan Provincial People's Hospital (CN), Peking University International Hospital (CN), First Affiliated Hospital of Anhui Medical University (CN), Ningxia Medical University General Hospital (CN), PLA Navy General Hospital (CN), First Hospital of China Medical University (CN), First Affiliated Hospital of Dalian Medical University (CN), Air Force General Hospital PLA (CN), Peking University Third Hospital (CN), Tianjin Hospital (CN), The First People's Hospital of Guiyang (CN), Shanghai Sixth People's Hospital (CN), Beijing Ditan Hospital (CN), Beijing Chuiyangliu Hospital (CN), Jiangsu Province Hospital (CN), Xiamen Chang Gung Hospital (CN), First Affiliated Hospital of Soochow University (CN), Guangdong Provincial People's Hospital (CN), Guizhou Provincial People's Hospital (CN), First Affiliated Hospital of Zhengzhou University (CN), Second Affiliated Hospital of Zhejiang University (CN), Zhejiang Taizhou Hospital (CN), Xijing Hospital (CN), Huashan Hospital (CN), Chinese People's Liberation Army (CN), Qilu Hospital of Shandong University (CN), Huazhong University of Science and Technology (CN), Tianjin Medical University (CN), Southern Medical University (CN), Hainan Medical University (CN), Nanjing Medical University (CN), Chongqing Medical University (CN), University of Hong Kong (HK), China Medical University (CN), Air Force Medical University (CN)
Lanzhou University, National Natural Science Foundation of China, Capital Medical University, Fourth Military Medical University, Key Programme, Key Research and Development Projects of Shaanxi Province
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Openalex Percentile: Top 12%
Musculoskeletal pain and rehabilitation
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