evidence-based and standardised recommendation
for such a promising approach.
Economic impact
The total costs per year associated with low back
pain, including loss of wages, have been estimated
to be 100 billion dollars in the US and range from 2
to 17 billion Euros in European countries. 5 In the UK,
low back pain is the most common cause of
disability among young adults, representing more
than 100 million work days lost per year, whereas in
the US this amounts to 149 million days of work per
year lost. 1
A study conducted in Europe identified poor
physical health, high functional disability and low
health-related quality of life as predictive factors of
high costs among patients with chronic low back
pain. 19 Another study involving patients admitted to
a multidisciplinary spine centre revealed healthcare
costs twice as high compared with patients in
primary care. 20 Unfortunately, most of the
recommended therapeutic avenues have not been
evaluated for cost-effectiveness, but exercise therapy
seems to be cost-effective for the treatment of
subacute and chronic low back pain, although not
superior to other interventions for neck and low
back pain. 21
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The pathophysiology of low back pain is
undoubtedly complex and further complicated by
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The economic impact of chronic low back pain
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significantly high, and it will only increase as the
population ages. The identification of specific and
effective biomarkers and anthropometric factors
for diagnosing and monitoring improvements,
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