Debunking the myth of 'unspecified back pain'
Written by: Liz Wullems-Griffioen, CMO Healactively
Reviewed by: Noah Köppel, Physiotherapist (Kantonsspital Winterthur, Switzerland) and Research Associate (Eastern Switzerland University of Applied Sciences - OST)
Back pain stands as a prevalent issue worldwide, often leading to significant discomfort and disability, even significant loss in quality of life. Among its classifications, 'unspecified back pain' or non-specific low back pain (NSLBP) emerges as a particularly ambiguous term. And according to the European Pain Federation at least 90% of back pain is diagnosed as ‘low back pain, unspecified’. Here we draw on insights from research conducted by the University of Zurich and published in the European Journal of Pain in 2024, to shed light on what 'unspecified back pain' truly means, why the term may be misleading, and how understanding it better can enhance patient care and outcomes.
What is 'Unspecified Back Pain'?
Unspecified back pain refers to discomfort in the lower back that cannot be directly attributed to any specific cause. This categorization is alarmingly broad, encompassing a vast majority of back pain cases encountered in clinical settings. However, this lack of specificity can lead to challenges in treatment, as it doesn't pinpoint an exact origin of the pain.
The Problem with 'Unspecified' Diagnosis
Labeling back pain as 'unspecified' has significant implications. First and foremost, it may lead to a generalized treatment approach, often relying heavily on medication without addressing the underlying issues or exploring potential specific causes. Research from the University of Zurich highlights the prescribing patterns for pain medications in primary care, noting a considerable reliance on non-steroidal anti-inflammatory drugs (NSAIDs) and, to a lesser extent, opioids, without necessarily delving into the root cause of the pain (source: Wirth, Brigitte; Schweinhardt, Petra (2024). Personalized assessment and management of non‐specific low back pain. European Journal of Pain, 28(2):181-198.).
Why the 'Unspecified' Label is Not Helpful
The broad label of 'unspecified back pain' can inadvertently promote a passive approach to treatment. Patients might receive generic advice or prescriptions that don't cater to their unique conditions. This approach overlooks the multifaceted nature of back pain, which can be influenced by physical, psychological, and social factors. A more detailed understanding and investigation of the pain can lead to personalized treatment plans, potentially offering more effective relief and long-term solutions.
Moving Towards a Solution
The key to overcoming the challenges posed by 'unspecified back pain' lies in embracing a more nuanced understanding of back pain. A growing body of research is now available encouraging health professionals to delve deeper into the patient's history, lifestyle, and symptoms to uncover potential underlying causes. Moreover, an interdisciplinary approach, incorporating physical therapy, psychological support, and lifestyle adjustments, alongside medication, can offer a more comprehensive treatment pathway.
At Healactively, founded by former chronic back pain patients, we believe in a holistic, customized approach to back wellness with programs based on the individual’s pain triggers, symptoms, lifestyle requirements, and back wellness goals. Take the Self-Assessment (link below) to see what your personalized back wellness program looks like.