Preventing chronic disability in patients with acute low back pain

Acute low back pain can become a chronic disability that involves emotional suffering, work loss, and high cost to patients and society. Patient visits with primary care physicians typically include only a brief social greeting, a brief history, and a physical examination; treatment recommendations may consist of a prescription for pain medication and general advice about self-care. In a stepped-care framework involving increasingly intensive treatment, the patient's fears and beliefs about the pain are addressed, reactivation treatment may be administered, and an interdisciplinary and intensive treatment approach may be used to discuss psychiatric comorbidity and secondary gain issues. Early intervention at the acute stage can significantly reduce the prevalence of chronic pain and disability and may reduce costs.