Low back pain remains the leading cause of disability worldwide, yet clinical practice has long struggled with a fundamental paradox: imaging findings rarely correlate with symptom severity, and most treatments deliver only modest, short-lived relief. A comprehensive JAMA narrative review arrives at a moment when prescribing habits, surgical rates, and patient expectations all require recalibration.
The review consolidates current understanding across the full spectrum of nonspecific low back pain — the category encompassing roughly 85–90% of cases where no definitive structural cause can be identified. It traces the interplay between nociceptive, neuropathic, and central sensitization pathways that drive pain chronification, while mapping epidemiological risk factors including sedentary behavior, psychosocial stress, sleep disruption, and occupational loading. Diagnostically, the authors outline red-flag screening criteria that distinguish the rare serious underlying pathology from the vast majority of benign, self-limiting presentations. On the treatment side, the review evaluates evidence tiers for physical therapies, pharmacological agents, psychological interventions such as cognitive behavioral therapy, and procedural options.
What makes this review particularly relevant is its implicit challenge to the biomedical model that has dominated low back pain management for decades. The persistent overuse of lumbar MRI in primary care, the continued prescription of opioids for chronic cases, and the relatively low uptake of multimodal biopsychosocial approaches all represent gaps between evidence and practice that this kind of authoritative synthesis is positioned to close. The review's publication in JAMA signals an intent to reach clinicians across specialties, not just spine specialists. Limitations inherent to narrative reviews apply — selection bias in source literature and the absence of quantitative pooling mean the conclusions are interpretive rather than statistically derived. Still, as a practical framework for generalist physicians managing one of medicine's most prevalent complaints, this represents a clinically useful, if not paradigm-shifting, consolidation of the field.