Current Evidence for Diagnosis of Common Conditions Causing Low Back Pain: Systematic Review and Standardized Terminology Recommendations |
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| Affiliation: | 1. Department of Physiotherapy, Faculty of Health Sciences, University of Ljubljana, Zdravstvena pot 5, Ljubljana 1000, Slovenia;2. Rivers Lab, Department of Rehabilitation and Movement Science, School of Health Professions, Rutgers University, 65 Bergen Street, Newark, NJ 07101, USA;1. Private Practice, Santee, California;2. Private Practice, Columbus, Ohio;3. Texas Chiropractic College, Pasadena, Texas;4. Palmer Center for Chiropractic Research, Davenport, Iowa;5. New York Chiropractic College, Seneca Falls, New York;6. Private Practice, Greenbelt, Maryland;7. Moody Health Center at Texas Chiropractic College, Pasadena, Texas;8. Logan University, Chesterfield, Missouri;1. National Health and Medical Research Council Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia;2. Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA;3. Northern Clinical School Kolling Institute of Medical Research, Royal North Shore Hospital, The University of Sydney, Sydney, New South Wales, Australia |
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| Abstract: | ObjectiveThe purpose of this systematic review is to evaluate and summarize current evidence for diagnosis of common conditions causing low back pain and to propose standardized terminology use.MethodsA systematic review of the scientific literature was conducted from inception through December 2018. Electronic databases searched included PubMed, MEDLINE, CINAHL, Cochrane, and Index to Chiropractic Literature. Methodological quality was assessed with the Scottish Intercollegiate Guidelines Network checklists.ResultsOf the 3995 articles screened, 36 (8 systematic reviews and 28 individual studies) met final eligibility criteria. Diagnostic criteria for identifying likely discogenic, sacroiliac joint, and zygapophyseal (facet) joint pain are supported by clinical studies using injection-confirmed tissue provocation or anesthetic procedures. Diagnostic criteria for myofascial pain, sensitization (central and peripheral), and radicular pain are supported by expert consensus–level evidence. Criteria for radiculopathy and neurogenic claudication are supported by studies using combined expert-level consensus and imaging findings.ConclusionThe absence of high-quality, objective, gold-standard diagnostic methods limits the accuracy of current evidence-based criteria and results in few high-quality studies with a low risk of bias in patient selection and reference standard diagnosis. These limitations suggest practitioners should use evidence-based criteria to inform working diagnoses rather than definitive diagnoses for low back pain. To avoid the unnecessary complexity and confusion created by multiple overlapping and nonspecific terms, adopting International Association for the Study of Pain terminology and definitions is recommended. |
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| Keywords: | Diagnosis Low Back Pain Evidence-Based Practice Systematic Review |
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