Is life becoming more of a pain?

Papers p 1577 The evidence for an epidemic of low back pain in the United Kingdom rests on the unrelenting rise in sickness and invalidity benefit payments for low back pain since the 1950s.1 Similar trends have been observed elsewhere in Europe, and the same period has also seen a steady rise in rates of general practice consultations for low back pain.2 3 Many have argued that these changes do not represent a true rise in the incidence of low back pain but an epidemic of work incapacity attributed to low back pain.1 Increasing acceptance of low back pain as a reason for sickness certification, particularly in the context of rising unemployment and lack of opportunities for rehabilitation, seems likely to have contributed to this, as have changes in social security provision.1–4 The underlying assumption is that the actual occurrence of low back pain in the general population has changed very little during the post war period. Data in this week's BMJ challenge that assumption (p 1577).5 The assumption is difficult …