A REPORT FROM THE 2ND INTERNATIONAL FORUM FOR PRIMARY-CARE RESEARCH ON LOW-BACK-PAIN - REEXAMINING PRIORITIES

Study Design. Consensus process. Objectives. Reexamining and redirecti ng the research agenda for low back pain in primary care. Summary of B ackground Data. Most research, publications, and funding have traditio nally been directed toward specialty and biologically oriented investi gations of ''spinal disorders'' from biomedical and biomechanical pers pectives. Beginning in the mid-1980s, primary care researchers began t o investigate this field in earnest, focusing on lower back pain as a pain syndrome within an individual, family, and community context. Unf ortunately, more progress has been made on what should not be done in diagnosing and treating lower back pain than on what should be done. M ethods. This was a modified group process designed to reach consensus among an international group of primary care lower back pain researche rs. Results. Nearly all of the research priorities from the initial 19 95 forum are still thought to be important, although only modest progr ess has been made on most of them. The priorities perceived to be the most feasible to investigate and the ones in which the greatest stride s have been achieved are in methodologic rather than substantive areas . Identifying subgroups of people with lower back pain is still given top ranking in 1997, but the priorities have changed dramatically. Gre ater emphasis is given to finding predictors and risk factors for lowe r back pain chronicity, improving self-care strategies, and stimulatin g self-reliance. New items now make up 50% of the top 10 priorities. i n general, the additions reflect a greater emphasis on expanding metho dologic avenues of injury. Conclusions. Methodologic advances; the enl istment of new techniques and disciplines, and redirected re search ef forts may facilitate progress in the diagnosisand treatment of lower b ack pain.