Back pain is one of the most common complaints. About nine out of ten adults experience an episode at some point in their life, and five out of ten working adults have episodes every year.

The prevalence of back and neck pain in adults has increased more than 100% in the last decade and continues to increase dramatically in the ageing population, affecting both men and women in all ethnic groups.

Back pain is a very complex complaint as it involves the whole pain system and can occur without any ongoing injury or damage to spinal structures. The experience of pain has a significant impact on functional capacity and occupational activities. Chronic spinal pain, as with any persisting pain complaint is associated with abnormal movement patterns as well as abnormal thinking and emotional states. The end result of this body and mind interaction is a lowered quality of life.

The diagnostic evaluation of anyone with spinal pain can be very challenging and requires complex clinical decision-making. Answering the question “what is the pain generator” requires an evaluation of the whole pain system.

In general, there is no association between the appearance of the spine structures on a CT or MRI scan and the experience of pain. The imaging only measures structure of the tissues and not the function of the pain system. Jumping to a decision based on imaging technologies can result in misdiagnosis leading to therapeutical mistakes.

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