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The Lancet series on low back pain: reflections and clinical implications
  1. Kieran O’Sullivan1,2,
  2. Peter B O’Sullivan3,4,
  3. Mary O’Keeffe5
  1. 1 Sports Spine Centre, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  2. 2 School of Allied Health, University of Limerick, Limerick, Ireland
  3. 3 School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
  4. 4 Bodylogic Physiotherapy, Perth, Western Australia, Australia
  5. 5 School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Kieran O’Sullivan, Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar; kieran.osullivan{at}

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The Lancet series of papers on low back pain (LBP)1–3 received considerable academic and media attention, and helpfully reinforced key messages from international guidelines. Box 1 highlights some of the series’ key messages. The series illustrated international, multidisciplinary consensus on management of LBP. The series provides the reader with a comprehensive review of the most promising solutions, ranging from stratified care according to clinical risk profiling, through integrated health and occupational care, changes to payment systems and legislation, as well as public health and prevention strategies. This is important as all too often, guidelines and systematic reviews focus on the effectiveness, or lack thereof, of particular treatment options in isolation, without considering the broader context within which treatments are delivered. Here, we reflect on three issues from the series and discuss the clinical implications.

Box 1

Lessons from the Lancet low back series

  • Low back pain (LBP) is a major global challenge, and back-related disability is increasing.

  • The majority of LBP is not serious and cannot be linked to a specific structure.

  • Most red flags have limited diagnostic accuracy.

  • Imaging use is often inappropriate for non-specific LBP.

  • Non-pharmacological treatments such as advice and activity should be first-line options in the treatment of non-specific LBP.

  • Opioids have small effects, but have …

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