Treating Low Back Pain

Prediction rules have yet to be published for the interventions listed as brief pain-management programmes, but there is evidence that some tools are useful in detecting psychosocial aspects of low back pain and are predictive of poor outcomes. In addition, the authors have limited evidence that using behavioural approaches as an adjunct to ongoing therapy is more effective in people who have high fear-avoidance--i.e., avoidance of certain physical activities for fear that such activities will cause back pain-than if the approach is totally physical. Applying a one-size-fits-all approach, and applying the brief pain-management programme or the manual therapy treatment to everyone regardless of presentation, might have obscured the potential effectiveness of treatment targeted more specifically to patients for whom it is more likely to be of benefit. The authors hope that in the not-too-distant future, practitioners will have good evidence to use screening tools and clinical prediction rules to help identify the subgroups of patients with low back pain most likely to benefit from particular therapies.