Looking Back on Back Pain: Trial and Error of Diagnoses in the 20th Century

Abstract

In the beginning of the last century, many heterogeneous etiologies coexisted. In the second half of the century, the theory of disc degeneration took over almost the entire literature about low back pain. Pre-existing theories disappeared, but re-entered the discussion in the last decade. Two factors seemed to influence this development: 1) a tendency to prefer organic, visible abnormalities as etiologies; and 2) an inclination to trust technical diagnostic results more than clinical judgment.

Do exercise and advice help to improve the symptoms of subacute low back pain?

“…1 The natural history of chronic low back pain follows the pattern of a relapsing-remitting illness, with often trivial strains resulting in debilitating but generally self-limited episodes. Most episodes of acute low back pain resolve within 12 weeks.…”

Indications for Surgical Fusion of the Cervical and Lumbar Motion Segment

“…The evolution of the concept of discogenic back pain is well described but remains controversial. 51,52 Underlying the theories about the mechanism of discogenic pain are studies investigating the nociceptive capacity of the intervertebral disc itself; distention of the disc by percutaneous administration of fluid can reproduce pain. 53,54 The latter finding has led to the use of discography to identify patients who may benefit from surgery.…”

The profile of people reporting with low back pain to a resource poor clinic in Cape Town

“…Low back pain (LBP) is a significant problem in many countries (Goubert et al, 2004;Jin et al, 2004;Walker et al, 2004), in addition to suffering and func tional limitation, it places an economic burden on both the individual and the state (Korthals de Bos et al, 2004;Luo et al, 2004;Lutz et al, 2003;Woolf and Pfleger, 2003). Lifetime incidences can be as high as 80% (Santos Eggimann et al, 2000) and in many countries a large percentage of the health budget is utilized on managing LBP (Santos Eggimann et al, 2000).…”

“…The most effective treatment for low back pain has not yet being identified (Lutz et al, 2003). Providing educa tion, information and advice have been found to be useful (Burton et al, 1999;Cherkin et al, 1996;Little et al, 2001;Rivero Arias et al, 2006;Schenk et al, 1996) and it has been recommended that these should be prioritized as inter vention strategies as they are simple and cost effective.…”