Low Back Pain: It's Time for a Different Approach

to question the efficacy of a treatment applied too late.

The fourth issue is the fragmented and episodic nature of care.22 Patients with back pain receive conflicting information and advice from medical specialists, allied health professionals, family members and friends, and, of course, the Internet.10,19 Optimal patient management is best delivered in a shared-care model with consistent messaging by primary care, specialist and rehabilitation professionals. Patients select what resonates with them or do nothing in the face of so many contradictory opinions. Many continue to search for something that is going to "fix" their back pain.

Recognizing the pitfalls in our current medical approach to LBP, we propose a paradigm shift to a more practical, stratified approach that changes the messaging and management of LBP to reflect what LBP is—a chronic human condition.4,11,12 We must be both proactive and preventative. The first step is convincing the patient that LBP is manageable albeit likely to recur. The goal is control, not cure, and control is not only possible, it is readily achievable. It consists of phases of symptomatic treatment while engaging the patient in self-management maintenance and preventative strategies. Most LPB arises from minor mechanical derangements that produce an identifiable compilation of symptoms suggesting a probable anatomical source and, more importantly, an initial patient-specific management strategy.11 Appropriate expectations, a primary focus on the return of function and as well as pain reduction, and long-term, self-directed control should reduce both the chronicity and health care utilization.4,12,23-25 Individuals without a specific mechanical pattern, who fail to respond or become less specific over time, or who have a concurrent non-spinal complaint require further attention. Up to 30% of patients with LBP have associated yellow flag psychosocial issues.12,20,26 Less commonly, there may be a red flag for non-mechanical causes such as inflammatory disease, infection, or tumour.27,28,29 Reliably screening for these unusual presentations is possible by through a precise, back-specific history and physical examination. The next three articles provide a practical approach that will enable you to confidently assess and initiate patient-specific management within the continuum of LBP.


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