A behavioral approach to managing chronic low back pain.

Most patients with chronic back pain have no defined disease for which there is a specific treatment. These patients demonstrate excessive illness behavior. The initial approach must be to rule out a treatable disease. Then the patient must accept that while activity may hurt, it will not harm. The patient and spouse must both understand that no further investigation or specific therapy will help. The family physician must teach patients to change their lifestyle through a program of progressive activity. Realistic expectations must be set, with return to a normal lifestyle and work as the ultimate goals.