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The Confusing World of Low Back Pain Research

© Dr. David L. Phillips

Recently a conference on back pain was held in Alberta and it was at once confusing, convoluted and transparent in its lack of direction. The purpose of this conference was to assess the sum of medical knowledge and current research on the subject of lower back pain. The conference was the 7th Annual Primary Care Forum. This group involves most of the heavy hitters in the scientific and research field of lower back pain. The Forum leads the world in evidence-based thought and clinical approaches to this huge and economically crippling problem.

Because lower back pain is the most common human ailment and because it uses more of our health hours and dollars than any other single condition, one would wonder why we seem so confounded by it. Oh, don't get me wrong, there are numerous treatments, lots of medication options, oodles of therapies, diagnostic procedures galore, but simply no consensus on virtually anything in the back pain field. The one burning question asked at the Alberta Forum was essentially 'Are we getting anywhere with this?'

According to the latest Lippincott, Williams and Wilkins monthly newsletter,The Back Letter, when these annual meetings-of-the-minds in the back pain field were conceived almost ten years ago, the leaders presented a set of defined research priorities that, they hoped, would soon be answered. These priorities, they assumed, would define and organize the endeavors of the world's low back scientists and then real strides could be made to tackle and reduce the burden of back pain to industry and society--faint hope it seems.

For your interest and analysis, here are the 10 burning questions that no amount of research, study and conferencing seems able to answer. I have slightly altered some wording to make a few of these points more readable.

• 1. Can different varieties or subgroups of low back pain be defined, and, if they can, what criteria can be used to differentiate among them?
• 2. What can be done to contain and reverse the epidemic of low back pain disability and cost in developed societies?
• 3. What psychological interventions are effective for low back pain?
• 4. What are the most effective ways of changing the way doctors and therapists deal with low back pain?
• 5. What are the "best" (i.e. cost-effective, satisfying, least dangerous) strategies for treating low back pain?
• 6. What can be done to improve the quality and value of low back pain research?
• 7. Is there a need for a new paradigm (direction) for thinking about low back pain?

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