The medical model and low back pain

Abstract

T he Task Force on Low Back Pain refers to nonspecific low back This is a euphemism for low back pain of nonorganic etiology (ie, the patient says my back hurts but the clinician feels the symptoms are in some way disingenuous). Given this reluctance of the Task Force to recognize that low back pain is a disorder, the conclusion that disability from low back pain should not be recognized is hardly surprising. The position of the Task Force is startling. Maybe there is a massive conspiracy on the part of patients to confuse and frustrate clinicians and the rest of society and fabricate a factitious illness. Or maybe low back pain is the ubiquitous price we pay both for living longer than our forebearers (without evolutionary censorship) and for assuming the upright posture. Likely, members of the Task Force are not individuals that engage in the heavy labor that is associated with a high incidence of low back pain. Likely, even if there was a problem with low back pain, members of the Task Force would have options for alternative living and work that would help deal with a low back pain disability. This reluctance of the Task Force to recognize that low back pain has a medical basis appears to stern from frustration with medical treatment of low back pain. Given that forms of cancer have no good treatment, would we deny that the medical model is nevertheless an appropriate framework by which to conceptualize these cancers? We may not have good treatments for many cases of low back pain, but there can hardly be a denial that low back pain fits into a medical model. Low back pain has a familiar pattern. Patients routinely have great difficulty with certain postures, such as that associated with driving a car. The pattern of muscle tenderness is repeated over and over. Other predictable