Chronic low back pain: the failure of organic medicine

In this issue of the journal, a series of 67 patients is presented with persistent or recurrent chronic low back pain and leg pain after insertion of a lumbar-disc prosthesis in a private hospital in Germany. A relationship between degenerative changes in the vertebral column and chronic low back pain is often assumed but lacks a scientific basis. Psychosocial factors are much more important than biomechanical factors in determining the outcome, but the interaction between these determinants is far more complicated than just 'having problems'. Accordingly, a multidisciplinary approach is the most successful mode of treatment, while local measures aimed at the vertebral column are generally ineffective or of unproven value. Patients will continue to seek magic cures from 'quacks with a knife' as long as medical specialists are insufficiently trained to deal with unexplained somatic symptoms.