Classifying non-specific low back pain for better clinical outcomes: current challenges and paths forward

Low back pain classification systems are structured assessments used to guide choices of more specific treatments. Classification systems examined in randomised controlled trials have limited effects on pain intensity and disability compared to non classified interventions. Potential reasons for the lack of efficacy include: (1) failing to assess multidimensional factors that contribute to pain, (2) relying on clinician judgement, (3) low accessibility and (4) poor classification reliability. Overcoming these limitations is critical to deciding whether classification systems can improve clinical practice. Only once these limitations are addressed can we feel certain about the efficacy, or lack thereof, of classification systems. This Viewpoint guides the reader through some limitations of common classification approaches, and presents a path forward to open-access, reliable and multidimensional precision medicine for managing low back pain.