Multidimensional Diagnostic Criteria for Chronic Non-Specific Low Back Pain Patients: A Narrative Review

Abstract

Background: Chronic non-specific low back pain (CNSLBP) is one of the most prevalent musculoskeletal disorders worldwide and a major cause of long-term disability. Despite its high burden, diagnosis remains challenging because most patients do not present with a single clearly identifiable pathological cause. Conventional diagnostic approaches based mainly on structural findings and imaging are often insufficient to explain symptom persistence, functional limitation, and variation in clinical presentation. This has increased interest in multidimensional diagnostic models that integrate physical, psychosocial, functional, and neurobiological domains. Objective: To synthesize the literature on multidimensional diagnostic criteria and assessment domains relevant to patients with chronic non-specific low back pain through a narrative review. Methods: A narrative review of the literature was conducted using major electronic databases, including PubMed, Scopus, and Google Scholar. Relevant studies and reviews were identified using terms related to chronic non-specific low back pain, diagnostic criteria, multidimensional assessment, biopsychosocial factors, functional evaluation, psychosocial screening, and pain mechanisms. The evidence was synthesized thematically around key diagnostic domains, including core criteria, common clinical features, psychiatric and medical comorbidities, psychosocial and functional consequences, and putative neurobiological mechanisms. Results: The reviewed literature showed that effective diagnosis of CNSLBP requires more than exclusion of specific spinal pathology. Core diagnostic criteria include pain located between the lower rib margin and gluteal folds, symptom duration exceeding 12 weeks, and absence of a clear specific pathological source. The evidence further demonstrated that physical examination, functional assessment, psychosocial screening, and movement-based evaluation are essential components of diagnosis. Common clinical features include diffuse axial pain, activity-related aggravation, and variable functional limitation, whereas psychiatric and medical comorbidities such as anxiety, depression, insomnia, hypertension, diabetes, and osteoarthritis frequently coexist. Psychosocial factors, particularly fear-avoidance, catastrophizing, reduced work participation, and disability, emerged as major contributors to symptom persistence. In addition, neurobiological mechanisms such as central sensitization and altered pain modulation were identified as important explanatory domains in a subgroup of patients. Overall, the findings support the use of multidimensional diagnostic frameworks, including biopsychosocial and movement-based classification models, to improve clinical reasoning and patient stratification. Conclusion: Chronic non-specific low back pain should be diagnosed using a multidimensional framework that extends beyond structural assessment to include functional, psychosocial, and neurobiological domains. Adoption of such an approach may improve diagnostic precision, enhance individualized rehabilitation planning, and support better clinical outcomes.