The impact of low back-related leg pain on outcomes as compared with low back pain alone: a systematic review of the literature

Clin J Pain. 2013 Jul;29(7):644-54. doi: 10.1097/AJP.0b013e31826f9a52.


Objectives: Low back pain (LBP) with leg pain, especially with findings of nerve root involvement, is considered as a poor prognostic indicator although it seems to have a favorable natural resolution. It is unclear whether patients with LBP and leg pain are at the more severe end of the spectrum as compared with patients with LBP alone or whether they are a distinct subgroup that would perhaps benefit from early identification of the condition and more targeted interventions. The purpose of this study was to investigate the impact of LBP-related leg pain on outcomes and use of health resources as compared with patients with LBP alone.

Methods: Systematic review of studies reporting separate outcomes of patients with LBP and LBP with leg pain and synthesis of available evidence. Literature search of all English language peer-reviewed publications was conducted using MEDLINE, EMBASE, and CINAHL for the years 1994 to 2010.

Results: Of the papers retrieved, 9 were included in the review. The heterogeneity of studies allowed only narrative analysis of findings. All studies reported worse health outcomes and increased use of health care with radiation of leg pain distally and with neurological findings, with the exception of psychological outcomes.

Discussion: LBP with pain radiating to the leg appears to be associated with increased pain, disability, poor quality of life, and increased use of health resources compared with LBP alone. These findings argue for early identification of these cases by health care professionals and pursuing effective treatments.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Comorbidity
  • Humans
  • Leg*
  • Low Back Pain / epidemiology*
  • Low Back Pain / therapy*
  • Neuralgia / epidemiology*
  • Neuralgia / therapy*
  • Pain Measurement / statistics & numerical data*
  • Prevalence
  • Risk Factors
  • Treatment Outcome