Reviews

Back pain

This week two articles in the BMJ suggest that the amount of back pain experienced in Britain has increased, largely as a result of increased reporting of mild to moderate symptoms (pp 1552, 1577). Medicine is unlikely to have the answer: rather, patients will overcome their pain by modifying their behaviour.

Most people who overcome chronic back pain do so by becoming more physically activewhether by walking more or taking up an exercise like yoga. OnHealth's consumer portal offers "Yoga at your desk," a series of fast loading animations and instructions that lead the user through a series of exercises (look in the toolbox at the foot of the home page at www.onhealth.com/).

As usual with common problems, there are as many websites that discuss back pain as there are seconds in the day, so I abandon the general search engines for my favourite medical portal, Hardin's Meta-Directory (www.lib.uiowa.edu/hardin/md/index.html), which is a directory of directories organised under broad specialty headings. This presents the usual classificatory difficulties of "deep" sitesthat is, those that require the user to make more than one click to reach the final informational destination. Does back pain belong under "anaesthesiology and pain, "rheumatology and arthritis," "orthopedics," "family medicine," or even possibly "neurology and neurosciences"? And how happy am I going to be clicking on each in turn, waiting for the page to download, and then using the "back" button once I discover it is irrelevant? That's why you need text word searching over the whole site, which happily is provided, and soon I have discovered a new informational tool, the US Department of Health's colossal amalgamation of guidelines at www.guideline.gov/. The first hit here pulls up an authoritative guide to assessment and management of back pain, as does a search on OMNI (www.omni.ac.uk/). Take your pick, and don't slouch at your screen.

Douglas Carnall. 

BMJ dcarnall{at}bmj.com