The use of a mechanism-based classification system to evaluate and direct management of a patient with non-specific chronic low back pain and motor control impairment—A case report

Abstract

Low back pain (LBP) is one of the most common and costly musculoskeletal pain syndromes, affecting up to 80% of people at some point during their lifetime (Katz, 2002; van Tulder et al., 2002; Ehrlich, 2003; Woolf and Pfleger, 2003). It is reported that in spite of the large number of pathological conditions that can give rise to LBP, 85% of these are without a detected pathoanatomical/radiological abnormality. This population is classified as having ‘non-specific’ (NS) LBP (Waddell, 1987, 2004; Dillingham, 1995) which often develops into a chronic fluctuating problem with intermittent flares (Croft et al., 1998; Burton et al., 2004). Optimal treatment for patients with NS-CLBP remains largely enigmatic. Randomized Controlled Trials (RCTs) have failed to find consistent evidence for improved outcomes (Goldby et al., 2000; Cairns et al., 2002; Assendelft et al., 2004; Frost et al., 2004). One explanation offered for the inability to identify effective treatments is the lack of success in defining sub-groups of patients who are most likely to respond to a specific treatment approach (Leboeuf-Yde et al., 1997; Borkan et al., 1998; Bouter et al., 1998). Indeed, it has been proposed that the ‘LBPgroup’ conceals a large heterogeneous group of patients (McKenzie, 1981; Spitzer, 1987; Borkan et al., 1998;