A Health- and Resource-Oriented Perspective on NSLBP

Nonspecific low back pain (NSLBP) is an important health issue of our time. Personal as well as economic factors, like suffering pain and experiencing disability on the one hand and enormous and still increasing costs to the economy and society on the other hand, display the importance of the matter. Tremendous research has been conducted in the last few decades on NSLBP. A PubMed search (June 17, 2013) on “low back pain” provided 22,980 hits, and when specifying for “low back pain, systematic review,” 3,134 hits were still generated. Most research has been done examining the development, risk factors, or therapeutic measures of NSLBP, but hardly any literature exists on resources related to NSLBP. The aims of this review are twofold. In order to shade light on the salutogenetic approach of NSLBP, and thus to focus on health instead of illness, the first aim is to facilitate the understanding of which therapeutic measures enhance the ability to cope with chronic NSLBP and enable (more) normal functioning in life. The second aim is to stimulate the understanding of resources protecting against the onset of NSLBP or against the development of chronic NSLBP and its resulting work absence. 1. Overview and Introduction to Nonspecific Low Back Pain 1.1. The Definition of Nonspecific Lumbar Back Pain In order to examine resources of NSLBP, a definition of NSLBP is first given. NSLBP refers to pain symptoms anywhere in the lower back between the twelfth rib and the top of the legs [1]. It is defined as “pain or discomfort, localized below the costal margin and above the inferior gluteal folds, with or without leg pain” [2, page 171]. No recognizable, specific pathology such as infection, tumor, osteoporosis, fracture, radicular syndrome, or cauda equina syndrome is attributable to the pain sensations [3]. It further excludes organic referred pain. About four out of five persons experience low back pain at least once in their lifetime [4] with a one-year prevalence of 15% to 45% in industrialized countries [2]. Since the natural history of NSLBP is favorable, most individuals recover within six weeks [2, 5]. However, not all individuals recover spontaneously, and if NSLBP persists for longer than 12 weeks, acute NSLBP becomes chronic NSLBP [6]. An epidemiological study with data out of 16 European countries estimates that 19% of the European population suffered from chronic pain in 2003. The largest category—with 47% out of this 19%—is based upon back pain [7]. A recent inception study presents even higher numbers: more than 40% of 973 individuals developed