Towards a model of back pain. The 3 circles of pain

A new model for back pain is introduced. Three major groups (or ''circles'') of pain are described for the use of clinicians. The 1(st) circle is comprised of patients with pain from genuine spinal (mainly discs or facets) origin. The main feature identifying this group is the organic pattern of pain, a concept which is described and discussed, and which is based on the history, the clinical signs, imaging tests and response to treatments. The 2(nd)circle consists in patients with diffuse and permanent back pain, without any organic pattern. The pain, presumed to be not spinal in origin, is attributed to a dysfunction in the pain pathways. The 3(rd) circle is comprised of patients with clear psychosocial risk factors and no evidence for a spinal origin of their pain. This model applies for lumbar or cervical pain, with or without radiculopathy. Classifying a given patient in one of the 3 circles is relatively easy. It should allow an easier management of the back pain patients.