Back pain is a 20th century medical disaster which is continuing to blight the 21st. Medicine can not fully explain simple backache. Chronic back pain and the disability that it causes are becoming more problematic in our society. What we need to be treating is not back pain but resolving the disability that back pain causes.

14% of the UK population will have back pain today. 39% of the population will have had back pain in the last month. 60-80% of people will suffer with back pain at some point during their life. 1% of people are permanently disabled by back pain. 6 - 10% of people will seek medical attention for their pain.

Back pain incidence over the last 40 years in the UK remains unchanged. The incidence of disability caused by the back pain has increased and the level of intervention has also increased.

Back pain resolves for the majority of patients within 6 weeks but returns intermittently in the majority of patients but becomes chronic and disabling in less than 15% of these patients.

The majority of patients with acute spinal pain can be managed in the primary care setting. However a small number of patients have significant pathology in this group such as tumours, fractures, infections and cauda equina lesions that require prompt diagnosis and specialist management. Any management strategy for the care of large amounts of patients with spinal pain needs to identify this sub group quickly and effectively. The Red Flag system is widely used to identify these patients. This requires high quality triage and imaging resources to prevent individual patient disasters.

Following appropriate triage and assessment the majority of patients can be managed with advice and analgesia, formal physiotherapy treatment is rarely required.

15% of patients will develop chronic pain and this sub group of patients will require more specialised treatment. Research shows that the sooner this treatment is commenced the better patients respond.

In some patients who have not responded and have persistent pain then spinal stabilisation surgery to improve their symptoms maybe appropriate.