Whole of community pain education for back pain. Why does first-line care get almost no attention and what exactly are we waiting for?

A recent series of back pain articles in The Lancet attracted a great deal of attention across the media, with the usual outrage at physios and doctors providing useless treatments, and the usual advice to sufferers to exercise and get psychological help. The authors—some of the most prolific back pain researchers on the planet—made a ‘call to action’ and it was a sensible one. But it was not really a new one—we have known for decades not to ‘take back pain lying down,’ that the vast majority of back pain episodes do not require surgery or long-term powerful analgesics, and that most will resolve over time if we do not mess them up. So how is it that we are still in this mire of spiralling costs and widespread disability?

When are we going to stop taking the very solid science and sensible calls to action just to see it mashed into an accusatory swing at doctors to clean up their act or sufferers to ‘get over it, change their mindset and exercise’?

Back pain is not a simple problem. There are many forces at play that propagate its widespread mismanagement. The massive elephant in the room—that entire professions appear to depend on the problem remaining unsolved—will be hard to tackle. In the meantime, the glar- ingly obvious cornerstone of best practice care that somehow keeps flying under the radar is education.