The key points covered in this chapter include:

• The size and nature of the problem.

• Work and disability issues.

• Treatment approaches.

for chronic low back pain.

Epidemiology

It is estimated that 60–80% of people will have low back pain (LBP) at some time in their life. The annual incidence of back pain in the UK is around 40%, with around 40% of sufferers visiting their general practitioner (GP) for help. Disability from back pain in people of working age is one of the most dramatic failures of health care in recent years. In 1998 the direct health care costs of LBP were estimated at 1.6 billion pounds to the UK. These are dwarfed by the indirect costs of LBP, related to lack of productivity and informal care services, estimated to be 10.7 billion pounds. This makes the so-called ‘back pain epidemic’ one of the costliest maladies in the Western world. Its greatest impact is on the lives of those affected and their families. However, it also has a major effect on industry through absenteeism and avoidable costs (the Confederation of British Industries estimate that back pain costs £208 for every employee each year) and at any one time 430,000 people in UK are receiving various social security benefits primarily for back pain.