LOW-BACK-PAIN - A 20TH-CENTURY HEALTH-CARE ENIGMA

Despite greater knowledge, expertise, and health care resources for sp inal pathologies, chronic disability resulting from nonspecific low ba ck pain is rising exponentially in western society. Medical care certa inly has not solved the everyday symptom of low back pain and even may be reinforcing and exacerbating the problem. An historic review shows that there is no change in the pathology or prevalence of low back pa in: What has changed is our understanding and management. There are st riking differences in health care for low back pain in the United Stat es and the United Kingdom, although neither delivers the kind of care recommended by recent evidence-based guidelines. Medical care for low back pain in the United States is specialist-oriented, of high technol ogy, and of high cost, but 40% of American patients seek chiropractic care for low back pain instead. National Health Service care for low b ack pain in the United Kingdom is underfunded, too little and too late , and 55% of British patients pay for private therapy instead. Despite the different health care systems, treat ment availability, and costs , there seems to be little difference in clinical outcomes or the soci al impact of low hack pain in the two countries. There is growing diss atisfaction with health care for low back pain on both sides of the At lantic. Future health care for patients with nonspecific low back pain should be designed to meet their specific needs.