[Back pain in primary care: a changing paradigm over time]

Abstract

Acute lumbar pain is a frequent problem in primary care. Specific problems can be easily ruled out based on personal history and clinical examination in the absence of the so called "red flags". The primary care doctor must then avoid to prescribe any unnecessary additional test, but emphasize the "functional" nature of the problem and the absence of organic lesions. Reassurance and prompt mobilization are key elements for a quick recovery. When lumbar pain becomes chronic, a therapeutic agenda based only on the biomedical model will fail, because causative organic lesions are generally absent. Instead, the bio-psychosocial approach can help to reestablish a favourable doctor-patient relationship, which integrates an active participation of the patient to establish common therapeutic goals.