Low back pain with radiating leg pain in primary care:Epidemiology, management and prognosis

This thesis investigates the epidemiology, management, and prognosis of low back pain with radiating leg pain in primary care. Radiating leg pain, which can be classified as either somatic (referred) or radicular (nerve-related), is a common and often more debilitating condition than localized back pain. Through a systematic review of international clinical practice guidelines, this research highlights a consensus on the diagnostic importance of physical examinations and a cautious approach toward routine imaging. However, the study also identifies significant inconsistencies across global guidelines regarding pharmacological treatments, particularly concerning the effectiveness and recommendation of specific painkillers. The research further explores the clinical course and prognostic factors of back pain with radiating leg pain in older patients (aged 55 and older) through the BACE cohort study. Findings indicate that the distal extent of radiation—specifically pain reaching below the knee—is associated with higher pain intensity, greater disability, and a higher psychological burden, including kinesiophobia and depressive symptoms. While most patients experience significant improvement within the first three months after visiting a general practitioner, several factors such as smoking, poor self-rated health, and psychological distress were identified as predictors of a poorer long-term recovery after one year. Finally, the thesis examines the real-world management of these patients within the Dutch healthcare system and evaluates the effectiveness of structured exercise programs. Analysis of large-scale primary care data in the Rijnmond region confirms that Dutch GPs generally adhere to guidelines by limiting MRI referrals, though medication prescription remains high. Additionally, the study demonstrates that a structured education and exercise intervention (GLA:D Back) is equally effective for patients with radiating leg pain as it is for those with localized back pain. These results emphasize the need for a biopsychosocial approach in primary care to better support patients at risk of chronic complaints.