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Low back pain (LBP) is an enormous socioeconomic and emotional burden. In spite of vast efforts, the number of LBP sufferers are rising and back pain endures as a clinical conundrum. While LBP is generally recognised as a complex condition, its care is becoming progressively discordant with clinical guidelines. We are increasingly prescribing MRI, strong pain medication, injection therapy and surgery, all with highly conflicting evidence of efficacy.1
For decades we have scanned, screened and tested. We have rubbed muscles and cracked joints. Spines have been cut, carved and fixated. However, on our seemingly never-ending quest to find the pathoanatomical ‘Holy Grail’ of pain, we seem to be forgetting something:
Our patients are not cars. And we are not mechanics.2 ,3
To move the field of LBP care forward, there is need for reconceptualisation. We cannot reasonably expect centuries of evolution to be marginalised into joints, muscles or …