Clinical introduction
Chronic low back pain (CLBP) is among the most common clinic complaints. The latest guidelines emphasize moving from a "drugs first" model to a multidimensional model that integrates physical, psychological and social aspects.
When to order an MRI?
Ordering an MRI too early is a common mistake. Guidelines recommend deferring imaging for 4–6 weeks unless red flags are present: unexplained weight loss, fever, progressive neurological deficit, or cancer history.
First-line therapy
- Physical therapy and strengthening exercises.
- Patient education and reassurance.
- Cognitive behavioral therapy for cases with anxiety or depression.
- Short courses of simple medications (NSAIDs) when needed.
When to refer for surgery?
Guidelines agree surgery is a very limited option, only after 6 months of failed conservative care, and when there is clear neurological deficit or cauda equina syndrome. Surgery without these indications can make things worse.
The best treatment for back pain is movement, not bed rest.
D
About the author
Dr. Allam
Specialized medical instructor, delivering high-quality educational content.
