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We need to rethink front line care for back pain

BMJ 2011; 342 doi: (Published 25 May 2011) Cite this as: BMJ 2011;342:d3260
  1. Jan Hartvigsen, professor, director of research for clinical biomechanics1,
  2. Nadine E Foster, professor of musculoskeletal health in primary care2,
  3. Peter R Croft, professor of general practice epidemiology2
  1. 1Institute for Sports Science and Clinical Biomechanics, Odense, Denmark
  2. 2Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
  1. jhartvigsen{at}

Back pain contributes substantially to workload and healthcare costs in primary care. It is the most common musculoskeletal problem in UK primary care and the second leading symptomatic cause for visits to the doctor in the United States (BMC Musculoskeletal Disorders 2010,11:144, doi:10.1186/1471-2474-11-144). In Denmark a family doctor sees on average at least one patient with back pain each working day.

Evidence from clinical trials indicates that treatment in primary care can achieve modest but definite improvement. Encouraging people to stay active and at work, helping patients adjust their beliefs and expectations to realistic but achievable goals, and offering simple analgesia and a range of physical therapies—such as exercise, manual therapy, and acupuncture—and support for rehabilitation to the workplace should result in less suffering, disability, and work loss. However, prevalence of chronic disabling back pain has increased in many countries, sickness absence rates remain high, and many patients seek care from healthcare professionals other than their family doctor. …

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