Recent highlights in low back pain research, Part I: Diagnosis and Prognosis.

INTRODUCTION

This paper highlights research relating to diagnosis and prognosis in low back pain (LBP) published between January 2020 and September 2025.

METHODS

To identify studies for inclusion, we searched Medline, CINAHL and the Cochrane Database of Systematic Reviews. Search results were screened and relevant studies were grouped according to their topic area. From those results, we selected studies that were perceived to be of great clinical importance, particularly high quality and/or controversial.

FINDINGS: This narrative review synthesised five key themes in LBP research. For Theme 1 (Serious pathologies presenting as LBP), we found that serious spinal conditions are rare, and clinicians should assess overall concern using a combination of alerting features rather than isolated red flags. In Theme 2 (Imaging in LBP management), we discussed the limited role of imaging, noting its continued overuse and frequent inappropriate application. In Theme 3 (Diagnostic uncertainty), we highlighted that LBP often lacks a clear anatomical cause and that embracing uncertainty while focusing on modifiable factors can help patients feel more supported and in control. Theme 4 (Clinical course and pain trajectories) showed that although recovery is common in recent onset LBP, recurrences are frequent; even long-lasting pain can improve. Traditional labels such as 'acute' and 'chronic' often fail to capture the fluctuating nature of LBP. Finally, in Theme 5 (Prognostic factors and prediction models), we presented patient characteristics related to delayed recovery but highlighted that current prediction models are not yet ready for clinical implementation. We provided direction for future research across all themes. The identified themes help clinicians make informed, evidence-based decisions and navigate current uncertainties in diagnosis and prognosis.