The evidence for effectiveness of different approaches is often diluted by
the inclusion of heterogeneous groups and, in this case, lack of agreement
over what constitutes 'acute' and 'chronic' back pain is a clear confoundin
g factor. Although there are undoubtedly common issues in the approach to t
hese problems, there are also clear differences. Closer definition of the p
roblem and the development of specific and targeted outcome measures is req
uired.
In common with other areas of musculoskeletal rehabilitation, the evidence
strongly supports exercise (except possibly in the rare case of true radicu
lar back pain) and a cognitive behavioural approach to pain management. The
variability of evidence in support of manipulation suggests that patient s
election is important, but as yet those selection criteria are not clear.
As is often the case, medical interventions are rarely submitted to evaluat
ion in terms of functional outcome so, for procedures such as epidurals and
facet joint injections, the jury is still out at the current time.