Low Back Pain—A Disease or Condition of Impaired Functional Health? Definition-Inherent Consequences for the Comprehensive Care of Back Pain Patients

Abstract

This article provides arguments for and against the classification of low back pain (LBP) as a disease or health condition. Based on the basic definitions of health, disease, illness, sickness, infirmity, and pain, little support has been found for the idea that LBP represents a specific disease entity. Although specified back pains do not signify disease, the pain experienced may be caused by specific diseases, such as inflammation, neuropathy, fractures, or tumors. Common findings in medical imaging indicate disk herniation, degenerative joints with or without signs of inflammation in the facet joints, and spinal stenosis present in a relatively high proportion of pain-free persons. The same applies to hypomobile segmental dysfunction (joint blockage) and myofascial syndrome. Both functional entities play a core role in manual medicine but are common in asymptomatic subjects, showing low–moderate reliability and failing to meet the classification requirements of disease. Reducing disability through interventions targeting a disease’s structural/functional conditions cannot be achieved since the relationship between pathological changes and activity restrictions/participation is indirect in most cases. Considering LBP as a condition shifts the goal of treatment from the disease to the patient’s optimal performance in activities/participation and allows them to be self-determined and independent.