Introduction

Recent debate has centred on whether psychological interventions that have reasonable evidence in the secondary care setting1 can be adapted to treat common complaints such as back pain in primary care. Last year a high-profile trial in America2 failed to demonstrate that individual treatment with early behaviourally oriented (psychologically informed) physical therapy provided additional benefits over a usual package of physical therapy, even when they examined their findings among the subgroup of patients with elevated levels of pain-related fear. Many others have similarly failed to show that primary care delivered, psychologically informed interventions for back pain are superior to the treatments with which they have been compared.3 The recent BEST trial has, however, shown that a low cost, primary care group intervention based on cognitive behavioural principles is superior …