Low back pain is virtually an epidemic in the United States. In many surveys, it is listed in the top 3 most frequent patient complaints resulting in a visit to a physician. It also appears to be more prevalent in the United States than in other industrialized societies, with only a muddle of theories available explain this costly difference. For this reason, a systematic methodology of evaluating the patient with back pain is clearly important. This would help the primary care physician, usually the first evaluate the patient, who is quietly worried that she or he might miss an ominous but uncommon etiology such as metastatic cancer. Also from the public health perspective, this methodology would help prevent multiple, unnecessary and costly imaging studies. And, in fact, many detailed evidence-based recommendations have been published over the years, going as far back as 1994.
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