Chronic pain--the end of the welfare state?

The problem of low back pain has reached epidemic proportions in the industrialized nations. The predicament of back pain is common, 30-40% of our populations from 10-65 years old report such trouble to occur on a monthly basis. In 1-8% this results in work-disabling back pain. Only in very few of these patients can physicians diagnose a definite pathoanatomical cause for the pain. It can be deduced that psychosocial factors, including insurance benefits are of importance for this variation. Sweden, with 100% sickness benefits, has the highest disability rate. Few non-surgical methods have proven effective in rendering the patient better for him to return to work. Even fewer studies demonstrate any benefit from surgery, simple open removal of a proven disc hernia being the only exception. For patients with unproven diagnostic labels such as facet arthritis, degenerative disc disease, internal disc resorption and instability, no evidence exists that any type of surgery is cost-effective. More attention must be paid to illness behaviour by anyone treating chronic low back pain syndromes (> 3 months). Such psychological reactions to an originally nociceptive pain stimulus somewhere in the motion segment, must be elucidated and addressed, before embarking on risky and expensive treatment modalities including surgery. It is time for all of us, politicians as well as physicians, to distinguish what types of support will contribute to our nations' future and which ones will undermine it. Our welfare systems are at stake.