{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T15:56:39Z","timestamp":1790524599766,"version":"4.1.0"},"reference-count":16,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Pract Neurol"],"accepted":{"date-parts":[[2025,11,12]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:p>According to the Global Burden of Disease Project (2021), back pain affects over half a billion people worldwide and is responsible for the most years lived with disability of any condition. Only a small fraction of these will ever see a neurologist, but those that do pose a range of difficulties, from attempting an accurate diagnosis to estimating prognosis and providing advice as to whether any interventions, particularly surgery, are likely to be better than the effect of time alone. There are many guidelines, mainly aimed at primary care practitioners. This article tries to provide succinct evidence-based messages for neurologists (and others in secondary care) to use with patients at different stages of back pain duration\u2014from acute to chronic\u2014to help in navigating some of these difficulties.<\/jats:p>","DOI":"10.1136\/pn-2025-004721","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T18:20:23Z","timestamp":1764613223000},"page":"449-455","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Low back pain, with or without sciatica"],"prefix":"10.1136","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3030-6062","authenticated-orcid":false,"given":"Harry","family":"McNaughton","sequence":"first","affiliation":[{"name":"Stroke\/Rehabilitation, Medical Research Institute of New Zealand, Wellington, New Zealand"},{"name":"University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivian","family":"Fu","sequence":"additional","affiliation":[{"name":"Stroke\/Rehabilitation, Medical Research Institute of New Zealand, Wellington, New Zealand"},{"name":"Department of Clinical Neuroscience, University of Calgary, Calgary, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravi","family":"Kothari","sequence":"additional","affiliation":[{"name":"University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,12,1]]},"reference":[{"key":"2026092100401133000_26.5.449.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30488-4"},{"key":"2026092100401133000_26.5.449.2","unstructured":"Getting It Right First Time . National suspected cauda equina pathway. 2023. Available: https:\/\/www.spinal.co.uk\/wp-content\/uploads\/2023\/08\/National-Suspected-Cauda-Equina-Pathway-February-2023-FINAL-V1-1.pdf"},{"key":"2026092100401133000_26.5.449.3","unstructured":"STarT back screening tool. Keele University; 2018. Available: https:\/\/startback.hfac.keele.ac.uk\/wp-content\/uploads\/2018\/11\/Keele_STarT_Back9_item.pdf"},{"key":"2026092100401133000_26.5.449.4","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1097\/00007632-199502001-00011","article-title":"Good prognosis for low back pain when left untampered. A randomized clinical trial","volume":"20","author":"Indahl","year":"1995","journal-title":"Spine (Phila Pa 1976)"},{"key":"2026092100401133000_26.5.449.5","unstructured":"WHO guideline for chronic lower back pain. 2023. Available: https:\/\/cdn.who.int\/media\/docs\/default-source\/mca-documents\/ageing\/lbp\/summary_who_guideline_lower-back-pain_brochure_v7.pdf?sfvrsn=80aec829_1"},{"key":"2026092100401133000_26.5.449.6","unstructured":"NICE Guideline . Low back pain and sciatica in over 16s: assessment and management. 2020. Available: https:\/\/www.nice.org.uk\/guidance\/ng59 [Accessed 24 Oct 2025]."},{"key":"2026092100401133000_26.5.449.7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199407143310201"},{"key":"2026092100401133000_26.5.449.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2015.12.001"},{"key":"2026092100401133000_26.5.449.9","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2022-070730","article-title":"Surgical versus non-surgical treatment for sciatica: systematic review and meta-analysis of randomised controlled trials","volume":"381","author":"Liu","year":"2023","journal-title":"BMJ"},{"key":"2026092100401133000_26.5.449.10","doi-asserted-by":"crossref","first-page":"1817","DOI":"10.1016\/j.spinee.2013.07.456","article-title":"Recovery of motor deficit accompanying sciatica--subgroup analysis of a randomized controlled trial","volume":"14","author":"Overdevest","year":"2014","journal-title":"Spine J"},{"key":"2026092100401133000_26.5.449.11","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp078052"},{"key":"2026092100401133000_26.5.449.12","doi-asserted-by":"crossref","first-page":"e347","DOI":"10.1016\/S2665-9913(21)00036-9","article-title":"Surgical microdiscectomy versus transforaminal epidural steroid injection in patients with sciatica secondary to herniated lumbar disc (NERVES): a phase 3, multicentre, open-label, randomised controlled trial and economic evaluation","volume":"3","author":"Wilby","year":"2021","journal-title":"Lancet Rheumatol"},{"key":"2026092100401133000_26.5.449.13","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-010-1504-9"},{"key":"2026092100401133000_26.5.449.14","doi-asserted-by":"publisher","DOI":"10.1136\/ard.62.2.127"},{"key":"2026092100401133000_26.5.449.15","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1136\/annrheumdis-2018-eular.6607","article-title":"FRI0587\u2005Low back pain due to enthesopathy of erector spine muscle: a comparative us and mri study in patients with iliac crest pain syndrome","volume":"77","author":"Todorov","year":"2018","journal-title":"Ann Rheum Dis"},{"key":"2026092100401133000_26.5.449.16","doi-asserted-by":"publisher","DOI":"10.1136\/pn-2023-003763"}],"container-title":["Practical Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/pn-2025-004721","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T15:28:12Z","timestamp":1790522892000},"score":1,"resource":{"primary":{"URL":"https:\/\/pn.bmj.com\/lookup\/doi\/10.1136\/pn-2025-004721"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,1]]},"references-count":16,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,9,20]]},"published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1136\/pn-2025-004721"],"URL":"https:\/\/doi.org\/10.1136\/pn-2025-004721","relation":{},"ISSN":["1474-7758","1474-7766"],"issn-type":[{"value":"1474-7758","type":"print"},{"value":"1474-7766","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,1]]}}}