Low back pain is neither a disease nor a diagnostic entity of
any sort. The term refers to pain of variable duration in an
area of the anatomy afflicted so often that it is has become a
paradigm of responses to external and internal stimuli ⎯for
example, “Oh, my aching back” is an expression used to
mean that a person is troubled. The incidence and prevalence
of low back pain are roughly the same the world over
— wherever epidemiological data have been gathered or estimates
made — but such pain ranks high (often first) as a
cause of disability and inability to work, as an interference
with the quality of life, and as a reason for medical consultation.
In many instances, however, the cause is obscure, and
only in a minority of cases does a direct link to some defined
organic disease exist.
This article does not deal with specific and attributable
low back pain that results from trauma, osteoporotic fractures,
infections, neoplasms, and other mechanical derangements
⎯ such causes can be identified and must be dealt
with appropriately. In the vast majority of instances the
cause of low back pain is obscure or nebulous, and these
cases are the focus of concern for WHO (1), whose
Community Oriented Programme for the Control of
Rheumatic Disease showed convincingly that it is present in
similar proportions in several countries. This is true even if
the low back pain is unrecognized ⎯ usually because of
social reasons; for example, where manual labour is the
norm, the absence of one labourer because of back pain is
barely noticed if another is available to do the work; in