Common low back pain (LBP) is the pain between the costal margins and the inferior gluteal folds; it is influenced by physical activities and postures, usually accompanied by painful limitation of motion, frequently associated with referred pain and not related to fractures, spondylitis, direct trauma or systemic conditions (neoplastic, infectious, vascular, metabolic or endocrine-related). The LBP has a wide range of possible causes (discal protrusion or strains, sprains, joint degeneration, etc.) and in most cases has unknown origins. The social and economical impact of LBP is enormous, since it affects more than 70% of the general population sometime in their life; 17-31% of general population are suffering from LBP at any one time. LBP has an important economic impact, because it is associated with high rates of sick leave and disability pensions. However, over the last 20 years, the frequency of LBP has stabilised; the Action has assisted in the quality and quantity of LBP research and useful results for LBP management have been obtained: – Misconceptions have been identified (bed rest is deleterious, activity is useful, prognosis is influenced by duration -not severity- of pain, fear worsens disability more than pain); – Some traditional treatments have shown to be useless or deleterious (bed rest, traction, surgery when not strictly necessary); – New treatments have been developed and have shown to be effective and safe (keeping as active as possible, treatments aiming at changing beliefs and attitudes) At the same time results obtained at research level have generally not been transferred to clinical practice. Therefore, it is hard for a clinician to remain correctly updated since too many papers, most of them of bad quality, with contradictory results are published especially in relation to non-clinical aspects (statistics, epidemiological design) The development of the pan-European Clinical Guidelines for LBP resulting from this Action are aimed at helping clinicians to make their decisions and such “evidence based” clinical guidelines will promote the transfer of research into clinical practice by: – Giving recommendations that should be clear and applicable (i.e. clinically meaningful; “do” or “do not” for a specific scenario) – Basing those clinical recommendations on the best available evidence (and identifying those recommendations for which no evidence is available and have been based on consensus) – Using standards on how a clinical guideline should be developed (“agree collaboration”) – Covering all the spectrum (prevention, acute and chronic patients) – Having available updated and evidence based guidelines , with no language biases (including evidence in several COST languages) – Being of a multidisciplinary and multinational character (better prepared to resist local, national or professional biases) – Being nationally or locally adaptable: It defines the “gold standard management” in ideal conditions and health authorities can apply the recommendations to local or national available resources. – Including “state of art” recommendations (identifying those based on “strong”, “moderate” or “limited” evidence, and those based on consensus because no evidence was available) An English version is now available on COST B13 Website http://www.lowbackpaineurope.org. National working groups have been encouraged to translate the guidelines into their own languages and adapt them to their specific setting, offer them for endorsement to local and national health authorities and professional bodies, and work to implement their use in practice.
