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Low back pain: an intermittent and remittent predicament of life
  1. Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, USA
  1. Professor Hadler, Department of Medicine, 3330 Thurston Building CB#7280, University of North Carolina, Chapel Hill, North Carolina 27599–7280, USA.

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For any of us to live a single year without a backache is abnormal. That is true throughout adult life. And that has, no doubt, always been true.

What is mutable is whether, and how, and how well we cope with another such challenge to our sense of invincibility. Mind you, this insight holds for many morbid events: headache and heart ache and heart burn and more. This is not to belittle the affliction; beyond the pain in the back, the contraction in daily functioning can rival severe heart failure. The difference is that we almost always recover from low back pain and we usually can remember a prior episode.

In the last half of this century, when the incidence of the experience of regional low back pain seems stable,1 something is happening to our tolerance. The numbers who are turning to others for help and the numbers who now find backache incapacitating have reached epidemic proportions. This trend defies a concerted effort at intervention that has recruited the cutting edge of allopathic medicine and whatever alternatives society can put forward. And this effort at recourse and redress accounts for an astounding transfer of wealth, much of which is brokered by an enormous public/private enterprise charged with indemnification. Whatever the motivation, whatever the ethic,2 a paradox is painfully clear; the approach to the predicament …

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