New approach to back pain

Low back pain is a topic that has not enjoyed the publicity that it deserves in medical circles. With its limited coverage in medical curricula, both in hospital and GP training programs, one would be forgiven for thinking it is an uncommon or unimportant complaint. Yet it is a popular topic in the media where cure claims abound. It is also the leading cause of disability in the workplace and a very common cause of presentation to healthcare providers, often non-medical practitioners.

The authors are well qualified to write about this topic: Bogduk is Professor of Pain Medicine at Royal Newcastle Hospital and McGuirk is a specialist in musculoskeletal and occupational medicine for the Hunter Area Health Service. They seek to redress many of the common misconceptions about low back pain by presenting an approach to diagnosis and management firmly supported by the evidence. Many readers may be surprised to hear that the evidence base for low back pain is stronger than that for most other common conditions, but that this evidence gives little support for the traditional orthopaedic approach. The evidence is presented with great clarity and links very logically with the algorithms for diagnosis and management. These algorithms gravitate towards precision diagnosis and treatment of the anatomical sources of back pain when conservative therapy has failed.

This book is essential reading for people involved in musculoskeletal medicine and medicolegal work, for rehabilitation providers, physical therapists, WorkCover and other insurance providers, and for independent medical assessors. It would also be a very useful reference text for general practitioners and supersedes most other books in this area. Especially useful are the sections on history, imaging and management. These sections will save a lot of nail-biting among practitioners who are nervous of missing dangerous conditions, or who think they need to routinely refer low back pain patients to orthopaedic surgeons or rheumatologists. Health economists may also find the concepts in this book informative, as cost savings abound in this billion-dollar heath expenditure pit.

C Scott MastersPresident, Australian Association of Musculoskeletal Medicine, Caloundra, QLD

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