A report from the Second International Forum for Primary Care Research on Low Back Pain. Reexamining priorities

Study Design. Consensus process. Objectives. Reexamining and redirecting the research agenda for low back pain in primary care. Summary of Background Data. Most research, publications, and funding have traditionally been directed toward specialty and biologically oriented investigations of 'spinal disorders' from biomedical and biomechanical perspectives. Beginning in the mid-1980s, primary care researchers began to investigate this field in earnest, focusing on lower back pain as a pain syndrome within an individual, family, and community context. Unfortunately, more progress has been made on what should not be done in diagnosing and treating lower back pain than on what should be done. Methods. This was a modified group process designed to reach consensus among an international group of primary care lower back pain researchers. Results. Nearly all of the research priorities from the initial 1995 forum are still thought to be important, although only modest progress has been made on most of them. The priorities perceived to be the most feasible to investigate and the ones in which the greatest strides have been achieved are in methodologic rather than substantive areas. Identifying subgroups of people with lower back pain is still given top ranking in 1997, but the priorities have changed dramatically. Greater emphasis is given to finding predictors and risk factors for lower back pain chronicity, improving self-care strategies, and stimulating self-reliance. New items now make up 50% of the top 10 priorities. In general, the additions reflect a greater emphasis on expanding methodologic avenues of inquiry. Conclusions. Methodologic advances, the enlistment of new techniques and disciplines, and redirected research efforts may facilitate progress in the diagnosis and treatment of lower back pain.