This issue of Pain: Clinical Updates examines whether low back pain (LBP) should be considered a straightforward consequence of injury/dysfunction in the spine, or the result of more complex processes involving nervous system processing of sensory information. The focus is on axial LBP rather than radiculopathy, and on chronic LBP rather than on transient episodes of LBP. This article is partly based on a chapter in Functional Pain Syndromes: Presentation and Pathophysiology, published by IASP Press in 2009.
In this issue of Pain: Clinical Updates we have contrasted the end-organ injury/dysfunction model of LBP with various alternatives that can be grouped as models stressing altered nervous system processing, and we have reviewed the kinds of evidence that would support one perspective over the other. In our view, there is no single answer to the question of which model more accurately re ects the physiology underlying LBP. The pain that most patients experience probably re ects a combination of EODM and ANSPM, with the relative con- tribution of the two kinds of processes varying from patient to patient. In the face of this ambiguity, clinicians face the dif cult task of trying to sort out the relative merits of the two models for individual patients.