The paper by Jellema and colleagues is the first to attempt systematically to incorporate psychosocial management in the treatment of back pain by general practitioners in a primary care setting.1 The success of pain management programmes in “reversing” the impact of chronic incapacity in a proportion of patients with apparently intractable chronic pain has led to an interest in secondary prevention,2 3 as the sort of factors that seemed to respond to cognitive behaviour therapy had also been shown to be early risk factors for chronicity.4 A specific focus by general practitioners on psychosocial obstacles to recovery has recently been …