ABSTRACT
A fractured bone causes immediate immobility at least of part of the body and more insidiously developing pain and stiffness are commonplace. A sudden onset of the symptoms is likely to be related to an important psychogenic input, but asynchrony between mood and joint symptoms is of poor prognosis. Back problems account for 2 per cent of all general practitioners' consultations and 25 per cent of orthopaedic referrals. Management of CLBP must include medication for any depression or tension and discussion of personal problems and conflicts, where relevant. Truly psychosomatic mechanisms may operate also, and an emotional problem is somatised. Since a large number of patients suffer chronic or recurrent backache which interferes with their pattern of living disproportionately to the degree of structural damage or abnormality. Operant conditioning and cognitive-behavioural manoeuvres are also necessary by the time the backache has become well established. A multidisciplinary approach is useful in all chronic musculoskeletal disorders.
