A narrative review of etiology and treatment approaches on non-specific low back pain

Background: Non-specific low back pain (NSLBP) is a prevalent musculoskeletal condition characterized by pain between the lower rib margins and gluteal folds, without a clear pathological cause identifiable through imaging or diagnostic tools. It affects a wide demographic, leading to functional limitations, reduced quality of life, and significant socioeconomic burden. Understanding the multifactorial etiology and exploring evidence-based treatment approaches is essential for effective management and prevention of chronicity.

Methods: This narrative review was conducted through a comprehensive search of peer-reviewed literature published between 2011 and 2024 using databases including PubMed, Scopus, and Google Scholar. Keywords such as "non-specific low back pain," "etiology," "biopsychosocial model," "exercise therapy," and "multidisciplinary approach" were used. Relevant articles were selected based on their relevance to NSLBP’s causes and treatment strategies. Both clinical guidelines and systematic reviews were included.

Results: The review revealed that NSLBP is a multifactorial condition with contributions from mechanical, psychosocial, and lifestyle-related factors. Physical contributors include postural dysfunction, muscle imbalance, and poor movement control, while psychological elements such as fear-avoidance behaviour, anxiety, and stress significantly influence pain persistence. Treatment approaches supported by evidence include a combination of education, individualized exercise therapy, manual therapy, and cognitive behavioural strategies. Multimodal and biopsychosocial interventions have shown better outcomes compared to monotherapies. Emphasis on patient-centred care, early intervention, and self-management strategies are key to long-term success.

Conclusion: NSLBP is a complex condition requiring a holistic and individualized treatment approach. Recognition of its multifactorial etiology is crucial for effective management. Integrating physical, psychological, and occupational components through a biopsychosocial model not only improves functional outcomes but also reduces recurrence and chronic disability. Future research should focus on optimizing personalized treatment algorithms and exploring long-term effects of combined interventions.