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Am Fam Physician. 2023;107(4):435-437

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Key Points for Practice

• Because no treatments for low back pain are clearly superior, patients should be engaged in shared decision-making about whether to consider nonpharmacologic, pharmacologic, or watchful waiting approaches to managing acute or chronic low back pain.

• Cognitive behavior therapy modestly improves pain and function in chronic low back pain.

• Although medications have limited benefit in low back pain, NSAIDs and duloxetine have the strongest evidence for benefit.

• Acetaminophen does not improve pain or function in low back pain compared with placebo.

From the AFP Editors

Low back pain is one of the most frequently experienced medical conditions, affecting 84% of adults in the United States at some point. Nearly 40% of adults will have experienced this type of pain within a three-month period. Low back pain is the leading cause of disability worldwide. The U.S. Department of Veterans Affairs and U.S. Department of Defense (VA/DoD) have published guidelines on the diagnosis and treatment of low back pain.

Evaluation of Low Back Pain

Because low back pain is common, the initial evaluation focuses on identifying patients with serious underlying conditions. Red flags (Table 1) are the most reliable indicators of serious or progressive neurologic deficits and serious conditions that warrant immediate imaging.

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Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, Assistant Medical Editor.

A collection of Practice Guidelines published in AFP is available at

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