Among all chronic pain problems and spinal pain conditions, low back pain (LBP) is the most common clinical and public health problem (Deyo et al. Spine (Phila Pa 1976) 31(23):2724–7, 2006). It is the leading cause of activity limitation and work absence throughout much of the world. There is a lack of consensus evidence for the indication and efficacy for many spine surgeries and interventions. Evidence of randomized controlled trials showed inconsistent results, depending on the setting of the study (Andersson et al. Spine (Phila Pa 1976) 31(14):1637–8, 2006; Freeman et al. Spine (Phila Pa 1976) 30(21):2369–77, 2005; Buchbinder et al. N Engl J Med 361(6):557–68, 2009; Wardlaw et al. Lancet 373(9668):1016–24, 2009; Manchikanti et al. Pain Physician 18(1):79–92, 2015; Friedly et al. N Engl J Med 371(1):11–21, 2014; Juch et al. (JAMA 318(1):68–81, 2017; Dreyfuss et al. Spine (Phila Pa 1976) 25(10):1270–7, 2000). There are multiple factors contributing to this reality. Diagnosis of spinal pathology that underlies the clinical LBP often is difficult. Correlation between anatomic pathology and clinical symptoms is weak. In this article, we will review the anatomic base of spinal pain, focusing on low back pain, and discuss some of the common potential “pain generators” and their overlapping symptomology. We will highlight the prevalence and characteristics of neuropathic pain in chronic LBP, emphasizing the change of somatosensory function and central neural processes in individuals with chronic LBP. We will discuss some of the comorbid psychological dysfunction in chronic LBP patients and its various penetrance in individual patients, as it relates to treatment outcomes. We propose a chronic LBP-focused registry to collect relevant information across the biopsychosocial domains of pain and outcome measurements, to guide individualized treatment.

We hope this effort will help to identify patient-specific factors that can be used for more precise diagnosis and to better predict treatment response and promote the progress from the current “evidence-based” medicine to a more “outcome-based” personalized medicine.