Are We Making Progress?

In Brief Study Design. Synthesis and analysis of presentation and discussion highlights, with a focus on emerging trends and promising new directions in primary care research on low back pain (LBP). Objective. To present a summary of findings, themes, and insights from the Tenth International Forum on Primary Care Research on Low Back Pain, a meeting of researchers designed to share the latest concepts, methods, and results of research on LBP diagnosis, treatment, and disability prevention. Summary of Background Data. Earlier Forum meetings have developed several common themes and general conclusions. These are contrasted with the presentations and discussions at the 10th International Forum. Results. Major themes included concerns about the epidemic of chronic, disabling LBP, associated treatments, iatrogenesis, and the “LBP medical industrial complex”; the variability and complexity of outcomes and how their importance differed across patients in defining recovery and recurrence; the power of nonspecific effects, expectations, and therapeutic alliance; and the challenges of identifying important therapeutic subgroups. New research addressed early risk factor screening and linked intervention, nonmedical approaches to reframe the LBP problem and avoid unnecessary care, cognitive and behavioral aspects of LBP, and ways to train clinicians to implement these innovations. More appropriate use of longitudinal designs and a greater focus on implementation research was called for. Conclusion. Although the field of primary care LBP research often seems to progress slowly, the Forum highlighted several important, promising developments that could substantially improve LBP research and primary care practice. Highlights of the 2009 Forum for Primary Care Research on Low Back Pain are summarized. Promising research is addressing the complexities of recurrence and recovery; the power of nonspecific effects, expectations, and therapeutic alliance; challenges in identifying and targeting subgroups; approaches to avoid unnecessary care; and enabling clinicians to implement the best evidence.