Korsryggsmerte, langvarig
Sist oppdatert: Sist revidert:
Sist revidert av:Ingard Løge
Definisjon:
Ryggsmerter av mer enn 3 måneders varighet. Kan skyldes for eksempel uheldig arbeidsstilling eller akutt belastning og kan opprettholdes eller forverres av psykososiale årsaker
Forekomst:
60-70% av befolkningen vil oppleve ryggsmerter en eller flere ganger i løpet av livet
Symptomer:
Lave ryggsmerter. Alarmsymptomer kan gi mistanke om alvorlig underliggende patologi
Funn:
Varierende funn avhengig av årsak og grad av smerter. Generelt nedsatt bevegelighet i alle plan, stram muskulatur og ømhet ved trykk både mot ryggvirvler og paravertebral muskulatur.
Diagnostikk:
Supplerende undersøkelser er vanligvis ikke nødvendig dersom det ikke foreligger røde flagg (alarmsymptomer)
Behandling:
Hovedprinsipp for behandling er i størst mulig grad å trosse smertene og opprettholde normal aktivitet
- Nasjonal faglig retningslinje for bildediagnostikk ved ikke-traumatiske muskel- og skjelettlidelser. Anbefalinger for primærhelsetjenesten. Oslo, Helsedirektoratet 2014. www.helsebiblioteket.no
- Formidlingsenheten for muskel- og skjelettlidelser. Nasjonale kliniske retningslinjer. Korsryggsmerter - med og uten nerverotaffeksjon. Sosial- og helsedirektoratet, 2007.
- Will JS, Bury DC, Miller JA. Mechanical Low Back Pain. Am Fam Physician. 2018 Oct 1;98(7):421-428. PMID: 30252425. PubMed
- Munk R, Storheim K, Zwart J-A, et al. Mens vi venter på nye retningslinjer for behandling av korsryggsmerter. Tidsskr Nor Legeforen, publisert 20. mai 2020. doi: 10.4045/tidsskr.20.0181 DOI
- Hill JC, Whitehurst DGT, Lewis M, et al. Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. Lancet 2011; 378: 1560-71. PubMed
- Suri P, Delaney K, Rundell SD, et al. Predictive Validity of the STarT Back Tool for Risk of Persistent Disabling Back Pain in a U.S. Primary Care Setting. Arch Phys Med Rehabil. 2018; 99:1533-1539. PMID: 29625095 PubMed
- Balagué F, Mannion AF, Pellisé F, Cedraschi C. Non-specific low back pain. Lancet. 2012;379(9814):482–491.
- Freburger JK, Holmes GM, Agans RP, et al. The rising prevalence of chronic low back pain. Arch Intern Med. 2009;169(3):251-258 . doi:10.1001/archinternmed.2008.543 DOI
- E Iordanova, C Røe, A Keller,et al. Langvarige korsryggssmerter og MR-forandringer i ryggvirvlene. Tidsskr Nor Legeforen 2010; 130: 2260-3. doi:10.4045/tidsskr.09.0122 DOI
- Chou D, Samartzis D, Bellabarba C, et al. Degenerative magnetic resonance imaging changes in patients with chronic low back pain: a systematic review. Spine (Phila Pa 1976) 2011; 36: S43-53. pmid:21952189 PubMed
- Andrade NS, Ashton CM, Wray NP, et al. Systematic review of observational studies reveals no association between low back pain and lumbar spondylolysis with or without isthmic spondylolisthesis. Eur Spine J 2015; 24: 1289-95. pmid:25833204 PubMed
- Ashar YK, Gordon A, Schubiner H, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA Psychiatry. Published online September 29, 2021. PMID: 34586357 PubMed
- Hartvigsen J, Hancock MJ, Kongsted A et al. What low back pain is and why we need to pay attention. Lancet 2018; 391: 2356–67. PMID: 29573870 PubMed
- Zaina F, Cote P, Cancelliere C, et al. A Systematic Review of Clinical Practice Guidelines for Persons With Non-specific Low Back Pain With and Without Radiculopathy: Identification of Best Evidence for Rehabilitation to Develop the WHO`s Package of Interventions for Rehabilitation. Arch Phys Med Rehabil. 2023. PMID: 36963709 PubMed
- Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010; 6: CD007612. Cochrane (DOI)
- Rubinstein SM, de Zoete A, van Middelkoop M, et al. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. BMJ 2019; 364: l689. pmid:30867144 PubMed
- Kwan-Yee Ho EK, Chen L, Simic M, et al. Psychological interventions for chronic, non-specific low back pain: Systematic review with network meta-analysis. BMJ 2022 Mar 30; 376:e067718. PMID: 35354560 PubMed
- Werner EL, Storheim K, Løchting I, Wisløff T, Grotle M. Cognitive Patient Education for Low Back Pain in Primary Care: A Cluster Randomized Controlled Trial and Cost-Effectiveness Analysis. Spine (Phila Pa 1976) 2016; 41: 455-62. pmid:26966970 PubMed
- Steffens D, Maher CG, Pereira LS, et al. Prevention of Low Back Pain: A Systematic Review and Meta-analysis. JAMA Intern Med 2016; 176: 199-208. doi:10.1001/jamainternmed.2015.7431 DOI
- Schaafsma FG, Whelan K, van der Beek AJ, et al. Physical conditioning as part of a return to work strategy to reduce sickness absence for workers with back pain. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD001822. DOI: 0.1002/14651858.CD001822.pub3 Cochrane (DOI)
- Tan L, Cicuttini FM, Fairley J, et al. Does aerobic exercise effect pain sensitisation in individuals with musculoskeletal pain? A systematic review. BMC Musculoskelet Disord. 2022;23:113. PMID: 35114987 PubMed
- Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD000335. DOI: 10.1002/14651858.CD000335.pub2 DOI
- Aleksiev AR. Ten-year follow-up of strengthening versus flexibility exercises with or without abdominal bracing in recurrent low back pain. Spine 2014; 39: 997-1003 PMID: 24732860 PubMed
- Kolber MR, Ton J, Thomas B et al.PEER systematic review of randomized controlled trials: Management of chronic low back pain in primary care. Can Fam Physician. 2021 Jan;67(1):e20-e30. PMID: 33483410 PubMed
- Smith BE, Littlewood C, May S. An update of stabilisation exercises for low back pain: a systematic review with meta-analysis. BMC Musculoskelet Disord. 2014 Dec 9;15:416. doi: 10.1186/1471-2474-15-416.
- Foster NE, Anema JR, Cherkin D et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet 2018; 391: 2368–83. PMID: 29573872 PubMed
- Enthoven WTM, Roelofs PDDM, Deyo RA, van Tulder MW, Koes BW. Non-steroidal anti-inflammatory drugs for chronic low back pain. Cochrane Database of Systematic Reviews 2016, Issue 2. Art. No.: CD012087. DOI: 10.1002/14651858.CD012087. DOI
- Wong JJ, Côté P, Ameis A, wt al. Are non-steroidal anti-inflammatory drugs effective for the management of neck pain and associated disorders, whiplash-associated disorders, or non-specific low back pain? A systematic review of systematic reviews by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur J Spin 2016; 25: 34-61. pmid:25827308 PubMed
- Enthoven WTM, Roelofs PDDM, Deyo RA, et al. Non‐steroidal anti‐inflammatory drugs for chronic low back pain. Cochrane Database of Systematic Reviews 2016, Issue 2. Art. No.: CD012087. DOI: 10.1002/14651858.CD012087. DOI
- Urquhart DM, Wluka AE, van Tulder M, et al. Efficacy of low-dose amitriptyline for chronic low back pain. A randomized clinical trial. JAMA Intern Med 2018. pmid:30285054 PubMed
- Urquhart DM, Hoving JL, Assendelft WJJ, Roland M, van Tulder MW. Antidepressants for non-specific low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD001703. DOI: 10.1002/14651858.CD001703.pub3 DOI
- Machado GC, Maher CG, Ferreira PH, et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ 2015; 350: h1225. doi:10.1136/bmj.h1225 DOI
- Chaparro LE, Furlan AD, Deshpande A, Mailis-Gagnon A, Atlas S, Turk DC. Opioids compared to placebo or other treatments for chronic low-back pain. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD004959. DOI: 10.1002/14651858.CD004959.pub4 DOI
- Helsedirektoratet (2021). Nasjonal veileder for vanedannende legemidler nettdokument. Oslo: Helsedirektoratet (sist faglig oppdatert 19. oktober 2021, lest 29. oktober 2021).
- Enke O, New HA, New CH, et al. Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis. CMAJ 2018; 190: E-786-E793. pmid:29970367 PubMed
- Shanthanna H, Gilron I, Rajarathinam M, et al. Benefits and safety of gabapentinoids in chronic low back pain: A systematic review and meta-analysis of randomized controlled trials. Plos Med 2017. doi:10.1371/journal.pmed.1002369 DOI
- Read SH, Giannakeas V, Pop P, et al. Evidence of a gabapentinoid and diuretic prescribing cascade among older adults with lower back pain. J Am Geriatr Soc 2021; 69: 2842-50. pmid:34118076 PubMed
- Wilkens P, Scheel IB, Grundnes O, Hellum C, Storheim K. Effect of glucosamine on pain-related disability in patients with chronic low back pain and degenerative lumbar osteoarthitis. JAMA 2010; 304: 45-52. Journal of the American Medical Association
- Bråten LCH, Rolfsen MP, Espeland A et al. Efficacy of antibiotic treatment in patients with chronic low back pain and Modic changes (the AIM study): double blind, randomised, placebo controlled, multicentre trial.. BMJ 2019; 367: I5654. pmid:31619437 PubMed
- Albert HB, Sorensen JS, Christensen BS, Manniche C. Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy. Eur Spine J. 2013 ;22(4):697-707. PMID: 23404353. PubMed
- Bråten LCH, Grøvle L, Espeland A, et al. Clinical effect modifiers of antibiotic treatment in patients with chronic low back pain and Modic changes - secondary analyses of a randomised, placebo-controlled trial (the AIM study). BMC Musculoskelet Disord 2020; 13: 458. pmid:32660517 PubMed
- Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low-back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD008112. DOI: 10.1002/14651858.CD008112.pub2. DOI
- Walker BF, French SD, Grant W, Green S. Combined chiropractic interventions for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. Art. No.: CD005427. DOI: 10.1002/14651858.CD005427.pub2 DOI
- Licciardone JC, Minotti DE, Gatchel RJ, et al. Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a randomized controlled trial. Ann Fam Med 2013; 11: 122-9. pmid:23508598 PubMed
- Ebadi S, Henschke N, Nakhostin et al. Therapeutic ultrasound for chronic low-back pain. Cochrane Database Syst Rev. 2014;3:CD009169. doi: 10.1002/14651858.CD009169.pub2. The Cochrane Library
- van Dillen LR, Lanier VM, Steger-May K, et al. Effect of Motor Skill Training in Functional Activities vs Strength and Flexibility Exercise on Function in People With Chronic Low Back Pain A Randomized Clinical Trial. JAMA Neurol 2021; 78: 385-95. pmid:33369625 PubMed
- Rivero-Arias O, Gray A, Frost H, Lamb SE, Stewart-Brown S. Cost-utility analysis of physiotherapy treatment compared with physiotherapy advice in low back pain. Spine 2006; 31: 1381-7. PubMed
- Furlan AD, Giraldo M, Baskwill A, et al. Massage for low‐back pain. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD001929. DOI: 10.1002/14651858.CD001929.pub3. DOI
- Wegner I, Widyahening IS, van Tulder MW, Blomberg SEI, de Vet HCW, Brønfort G, Bouter LM, van der Heijden GJ. Traction for low-back pain with or without sciatica. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD003010. DOI: 10.1002/14651858.CD003010.pub5 DOI
- Will JS, Bury DC, Miller JA. Mechanical Low Back Pain. Am Fam Physician. 2018;98(7):421-428. PubMed
- Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD003008. DOI: 10.1002/14651858.CD003008.pub3 DOI
- Friedrich M , et al. Long-term effect of a combined exercise and motivational program on the level of disability of patients with chronic low back pain. Spine 2005; 30: 995-1000. PubMed
- Natour J, Cazotti LD, Ribeiro LH, et al. Pilates improves pain, function and quality of life in patients with chronic low back pain: a randomized controlled trial. Clin Rehabil. 2014. PMID: 24965957 PubMed
- Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017;389(10070):736-747. PubMed
- Karshikoff B, Jensen KB, Kosek E, et al Why sickness hurts: a central mechanism for pain induced by peripheral inflammation. Brain Behav Immun. 2016;57:38-46. PubMed
- Nicholas M, Vlaeyen JWS, Rief W, et al; IASP Taskforce for the Classification of Chronic Pain. The IASP classification of chronic pain for ICD-11: chronic primary pain. Pain. 2019;160(1):28-37. PubMed
- Clauw DJ. Diagnosing and treating chronic musculoskeletal pain based on the underlying mechanism(s). Best Pract Res Clin Rheumatol. 2015;29(1):6-19. PubMed
- Henschke N, Ostelo RWJG, van Tulder MW, Vlaeyen JWS, Morley S, Assendelft WJJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 7. Art. No.: CD002014. DOI: 10.1002/14651858.CD002014.pub3. DOI
- Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD001351. DOI: 10.1002/14651858.CD001351.pub2. DOI
- Parreira P, Heymans MW, van Tulder MW, Esmail R, Koes BW, Poquet N, Lin CWC, Maher CG. Back Schools for chronic non‐specific low back pain. Cochrane Database of Systematic Reviews 2017, Issue 8. Art. No.: CD011674. DOI: 10.1002/14651858.CD011674.pub2. DOI
- Mu J, Furlan AD, Lam WY, Hsu MY, Ning Z, Lao L. Acupuncture for chronic nonspecific low back pain. Cochrane Database Syst Rev. 2020;12(12):CD013814. Published 2020 Dec 11. The Cochrane Library
- Little P, Lewith G, Webley F et al. Randomised controlled trail of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and reccurent back pain. BMJ 2008; 337: a884. PubMed
- Engers AJ, Jellema P, Wensing M, van der Windt DAWM, Grol R, van Tulder MW. Individual patient education for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD004057. DOI: 10.1002/14651858.CD004057.pub3 DOI
- Herman PM, Anderson ML, Sherman KJ, et al. Cost-effectiveness of Mindfulness-based Stress Reduction Versus Cognitive Behavioral Therapy or Usual Care Among Adults With Chronic Low Back Pain. Spine (Phila Pa 1976). 2017. PMID: 28742756 PubMed
- Cramer H, Lauche R, Haller H, Dobos G. A systematic review and meta-analysis of yoga for low back pain. Clin JPain 2013; 29: 450-60. pmid: 23246998 PubMed
- Wieland LS, Skoetz N, Pilkington K, et al. Yoga treatment for chronic non-specific low back pain. Cochrane Database Syst Rev. 2017; 1: CD010671. pmid:28076926 PubMed
- Wells C, Kolt GS, Marshall P, et al. The effectiveness of Pilates exercise in people with chronic low back pain: a systematic review. PLoS One. 2014; Jul 1;9(7): 100402. pmid:24179139 PubMed
- Patti A, Bianco A, Paoli A, et al. Effects of Pilates exercise programs in people with chronic low back pain: a systematic review. Medicine (Baltimore). 2015;94(4):e383. PMID: 25634166 PubMed
- Yamato TP, Maher CG, Saragiotto BT, et al. Pilates for low back pain. Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD010265. DOI: 10.1002/14651858.CD010265.pub2 DOI
- French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD004750. DOI: 10.1002/14651858.CD004750.pub2. The Cochrane Library
- MacRae CS, Lewis JS, Shortland AP, et al. Effectiveness of rocker sole shoes in the management of chronic low back pain: a randomized clinical trial. Spine 2013; 38: 1905-12. doi:10.1097/BRS.0b013e3182a69956 DOI
- Yavin D, Casha S, Wiebe S, et al. Lumbar Fusion for Degenerative Disease: A Systematic Review and Meta-Analysis. Neurosurgery. 2017;80(5):701-715. PubMed
- Christensen FB, Bunger C. Stabilisation surgery for chronic low back pain: indications, surgical procedures and outcome. Scand J Rheumatol 2004; 33: 210-7. PubMed
- Fairbank J, Frost H, Wilson-MacDonald J, Yu LM, Barker K, Collins R, for the Spine Stabilisation Trial Group. Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial. BMJ 2005; 330:1220-27. British Medical Journal
- Bjerkeset T, Johnsen LG, Kibsgaard L et al. Kirurgisk behandling av degenerative korsryggslidelser Tidsskr Nor Lægeforen 2005; 125: 1817-9. PubMed
- Brox JI, Reikeras O, Nygaard O, et al. Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation: A prospective randomized controlled study. Pain 2006; 122: 145-55. PubMed
- Rognsvåg T, Strand LI, Skouen JS. Smerte- og funksjonsforløp hos pasienter med lumbal skiveprotese. Tidsskr Nor Lægeforen 2007; 127: 1188-91. PubMed
- Hellum C, Johnsen LG, Storheim K, et al. Surgery with disc prosthesis versus rehabilitation in patients with low back pain and degenerative disc: two year follow-up of randomised study. BMJ 2011; 342: d2786. BMJ (DOI)
- Jacobs W, Van der Gaag NA, Tuschel A, de Kleuver M, Peul W, Verbout AJ, Oner FC. Total disc replacement for chronic back pain in the presence of disc degeneration. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD008326. DOI: 10.1002/14651858.CD008326.pub2 DOI
- Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low-back pain. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD001824. pmid: 18646078 PubMed
- Nguyen C, Boutron I, Baron G et al. Intradiscal Glucocorticoid Injection for Patients With Chronic Low Back Pain Associated With Active Discopathy: A Randomized Trial. Ann Intern Med. 2017 Mar 21. Epub ahead of print pmid: 28319997 PubMed
- Waseem Z, Boulias C, Gordon A, Ismail F, Sheean G, Furlan AD. Botulinum toxin injections for low-back pain and sciatica. Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No.: CD008257. DOI: 10.1002/14651858.CD008257.pub2. DOI
- Hooten WM, Cohen SP. Evaluation and Treatment of Low Back Pain: A Clinically Focused Review for Primary Care Specialists. Mayo Clin Proc. 2015 Dec;90(12):1699-718. pmid: 26653300. PubMed
- Maas ET, Ostelo RWJG, Niemisto L, Jousimaa J, Hurri H, Malmivaara A, van Tulder MW. Radiofrequency denervation for chronic low back pain. Cochrane Database of Systematic Reviews 2015, Issue 10. Art. No.: CD008572. pmid: 26495910 PubMed
- U.S. Preventive Services Task Force. Brief evidence update: primary care interventions to prevent low back pain. Accessed January 10, 2007, at: http://www.ahrq.gov/clinic/3rduspstf/lowback/lowbackup.htm.
- Burton AK, Balague F, Cardon G, Eriksen HR, Henrotin Y, Lahad A, et al., for the COST B13 Working Group on European Guidelines for Prevention in Low Back Pain. How to prevent low back pain. Best Pract Res Clin Rheumatol 2005; 19: 541-55. PubMed
- Bigos SJ, Holland J, Holland C, et al. High-quality controlled trials on preventing episodes of back problems: systematic litterature review in working-age adults. Spine 2009; 9: 147-68. PubMed
- Buchbinder R, Jolley D, Wyatt M. Population based intervention to change back pain beliefs and disability: three part evaluation . BMJ 2001; 322: 1516-20. PubMed
- Carragee EJ, Hannibal M. Diagnostic evaluation of low back pain. Orthop Clin North Am 2004; 35: 7-16. PubMed
- Pengel LHM, Herbert RD, Maher CG, Refshauge KM. Acute low back pain: systematic review of its prognosis. BMJ 2003; 327: 323-8. British Medical Journal
- Costa LCM, Maher CG, McAuley JH, et al. Prognosis for patients with chronic low back pain: inception cohort study. BMJ 2009; 339: b3829. BMJ (DOI)
- Ingard Løge, spesialist allmennmedisin, redaktør NEL
Tidligere fagmedarbeidere
- Kurt Østhuus Krogh, spesialist i barnesykdommer, Redaksjonsmedarbeider NHI/ overlege Barne- og ungdomsklinikken, St. Olavs Hospital
- Arild Aamodt, overlege/professor, Ortopedisk avdeling, Lovisenberg Sykehus, Oslo
- Even Lærum, professor i allmennmedisin, Institutt for samfunnsmedisinske fag, Universitetet i Oslo
- Magne Rø, overlege Fysikalsk medisinsk avdeling, Regionsykehuset i Trondheim, og førsteamanuensis Norges teknisk-naturvitenskapelige universitet, Trondheim