Back pain: Tired of trying to fit square pegs into round holes?

Have you ever found that your back pain patient doesn’t fit into whatever classification system that you have been taught? Have you ever got confused because the different ways to classify back pain seem to contradict each other or miss out on some important factors relating to your patient? This paper takes a critical look at the main current back pain classification systems through the lens of four patients with chronic back pain. It highlights the strengths and limitations of the different systems, and concludes that any rigid system does not account for the enormous variety we see in our patients with back pain. It is proposed that a flexible, multidimensional framework considering the relative dominance of specific dimensions (e.g. physical, cognitive, psychological, lifestyle) is necessary to facilitate targeted management in this condition.

Martin Rabey is a Specialist Musculoskeletal Physiotherapist (as awarded by the Australian College of Physiotherapists in 2009). He has worked as an Extended Scope Orthopaedic Practitioner at St. Mary’s Hospital in London, and more recently in the Spinal Surgery Department at Royal Perth Hospital, Perth Western Australia. He has lectured in the UK and Europe on neck pain, headache, and knee pain. He is currently lecturing in anatomy and pathology, and musculoskeletal science at Curtin University, Perth, where he is undertaking his doctoral degree on multidimensional patient profiles in chronic low back pain. He currently also practices part-time at BodyLogic Physiotherapy in Perth.