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  1. Richard Lehman, MRCGP, MA
  1. Department of Primary Care, Oxford University
 Oxford, UK

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 The human spine, particularly its lowest 5 segments, has come in for a lot of criticism; but we should not forget that it also provides a living for millions of people such as osteopaths, chiropractors, acupuncturists, reflexologists, plus manufacturers of orthopaedic beds, TENS machines, and other purveyors of “guaranteed relief.” For most doctors, however, back pain is just a pain. Patients come to us expecting a diagnosis and some rational treatment, but with chronic back pain, all we can do is share their frustration and learn a bit of humility. In the UK, physiotherapy (physical therapy) has always been incorporated into the NHS whereas manipulative therapies have not. A British cost utility analysis (

    ) finds that it makes no difference whether a physiotherapist gives active treatment or just advice. “Back schools” have also become a popular way of getting people back to work after back pain, though there is little evidence that they work: a Dutch study ( ) found that a high intensity course produced the same result …

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