Summary

Back pain is the primary cause of disability in people <50 years of age. The annual incidence in the adult population is 10% to 15% with a point prevalence of approximately 30% in developed countries. Low-back pain (LBP) is second only to upper respiratory problems for physician visits each year, with a lifetime prevalence of 70% to 85%. Despite its widespread prevalence, the general prognosis of acute LBP is favourable, as 90% of patients recover without sequelae. [1] Recurrences are common, but most relapses are not disabling. A smaller subset of the population may be incapacitated from chronic LBP, defined as symptoms persistent for >6 months. Depression, job dissatisfaction, and medico-legal issues involving financial compensation predispose a patient to suffer long term. [2] [3] [4] [5] Several studies have demonstrated that the longer a patient is absent from work, the less likely he or she will return to work. [6] Furthermore, a small percentage of patients will develop persistent disabling LBP resulting in immense costs to society. Estimates approach $50 billion per year in the US. [7] [8] [9] [10] A review article found that maladaptive pain coping behaviours, non-organic signs, functional impairment, general health status, and presence of psychiatric comorbidities increased the risk of developing disabling LBP. The clinician should be aware of these risk factors when counselling and treating patients. [11]