A New Epidemic: Back Pain
Experts who track diseases, illnesses, and other medical conditions say that nonspecific (unknown cause) low back pain (LBP) has become an epidemic. Eight out of 10 adults will suffer from some form of LBP. Twenty percent will go on to have chronic pain. Doctors need some answers on how to treat LBP patients.

In this review article, researchers summarize findings of studies on acute, subacute, and chronic LBP patients. They also include national and international guidelines on the treatment and management of LBP. A special focus was placed on knowing who needs surgery and how to prevent disability.

Best evidence says that acute pain (first month) should be managed with pain relievers and activity. A few sessions of spinal manipulation may help. Subacute pain (one to four months) responds to physical activity and exercise. Adding behavioral treatment reduces time lost at work.

Chronic LBP patients (more than three months) remain a mystery. Many different treatments have been tried. There has been varying amounts of success. Surgery works for some but programs geared toward psychology and behavior work just as well. It's not clear yet who should get which type of treatment.

The authors say the bottom line is that patients and doctors must talk about treatment choices. The patient should be told what to expect with each one. Any risk factors for chronic pain should be identified in the first three months. In the end the patient must be responsible for managing his or her LBP.
Margareta Nordin, DrSci, et al. Nonspecific Low-Back Pain. Surgical Versus Nonsurgical Treatment. In Clinical Orthopaedics and Related Research. February 2006. No. 443. Pp. 156-167.