LOW-BACK-PAIN - A CRITICAL ANALYSIS OF TH E STATE-OF-THE-ART

Despite Low Back Pain (LBP) major health impact, its nosology, etiolog y and natural history remain ill defined in most cases. The studies of our team explored the clinical and psychological features of non spec ific low back pain on unselected populations of patients. Our first st udy was conducted in a department of rheumatology. Using multivariate satitistical methods we were able to identify three major groups of su bjects a first group called ''purely organic'', a second group called ''purely psychiatric'', a third group with both organic and psychiatri c features. These last two groups gathered 41 % of the subjects. An ot her complementary study was conducted in primary care practice. Using the General Health Questionnaire 38 % patients - a close to the above reported percentage - were classified as having a psychological disord er. In order to describe the natural course of acute low back pain an inception cohort study was conducted in primary care practice. A high rate of fast recovery was found. A critical look of the present knowle dge on Low Back Pain shows several unsatisfactory chapters. Further st udies on the natural history of LBP, studies on the precise etiology o f each variety and researches on their pathophysiology are needed to c omplete the description of nosologicaly well defined entities and to p ave the way for relevant well designed therapeutic trials.