The plethora of available treatment methods for low back pain (LBP) is a clear testimonial to the lack of efficacy of any one method to significantly reduce low back pain. This problem has been so elusive that we try and give names to it that reflect our inability to understand its root causes: failed back syndrome, mechanical low back pain, idiopathic low back pain, non specific low back pain and the descriptors continue to grow. In a recent interview with a prominent spine journal, the lead researcher of the APS review, Roger Chou, MD, was asked the question whether there had been progress in understanding the etiology of back pain. His answer was “Overall I would say yes. Even if we have to conclude that we do not yet understand the association between some exposures and low back pain, that in itself is an advance in knowledge.” This is a humbling reminder that back pain continues to be ubiquitous and its incidence has been relatively unaffected by current treatment interventions including both surgical, non-surgical invasive, and conservative modes of treatment.1 There appears to be a greater clarity amongst clinicians and researchers that low back pain is probably not related to any one single factor. Rather there are a number of risk factors for any one person and that future research will need to tease out which set of factors is most relevant to that subset of people at most risk for developing back pain.
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