[Psychological and psychosocial factors in chronic backache. Findings and social medicine consequences]

In the last ten years, chronic back pain has reached epidemic proportions and plays a major role in work absenteeism, medical rehabilitation costs and early retirement due to occupational disability. Studies into the development of chronic back pain prove that psychogenic and psychosocial factors are far more significant than organically determined phenomena and additional medical findings made using technical equipment. As well as the patient's history and early stress factors, other issues play a major role, such as workplace, job satisfaction and the individual's ability to handle conflict. The duration of the patient's inability to work and the use of purely somatically oriented, passive therapies are also of particular significance. In practice, there is a huge discrepancy between guideline-based knowledge and actual treatment measures. Patients with chronic back pain should be put on multi-modal rehabilitation treatment programmes at an early stage. Given appropriate rehabilitation measures, the socio-medical prognosis for this group of patients can be considered good, with 60 to 70% remaining in the world of work over a five-year period. To conclude, problems surrounding the assessment of chronic back pain sufferers are discussed.