Evaluation and management of back pain: preventing disability

Musculoskeletal pain has become a major public health problem with medical, occupational and socioeconomic implications. This paper reviews the problem of musculoskeletal back pain, impairment and implications for disability with specific reference to recent meta-analyses such as those performed by the Agency for Health Care Policy and Research (1994) and the IASP Task Force on Pain in the Workplace (1995). Data from these and other studies are consistent with our clinical findings suggesting that most cases of low back pain are idiopathic with an obscure etiology. As such they should be classified as non-specific low back pain (NSLBP) or back pain of undetermined etiology. The authors suggest that despite a paucity of objective findings many patients receive diagnoses difficult to justify and extensive diagnostic evaluation, some of which may be inappropriate and contribute to iatrogenic disability. Principles for appropriate diagnostic and therapeutic management are discussed with specific attention to risk factors likely to adversely influence treatment outcome and contribute to unnecessary disability.