Chronic low back pain

Editor—The Faculty of Occupational Medicine has published relevant guidelines on the management of low back pain.¹ These are recommendations based on an evidence review, and are primarily concerned with occupational aspects such as prevention and rehabilitation into work. None the less, they include clinical management and in general concur with the advice Samanta et al give in their article.²

Samanta et al suggest that patients let pain be their guide when judging activity levels. The faculty guidelines, reflecting the Royal College of General Practitioners' guidelines on clinical management, have a subtle but important difference. They emphasise the importance of continuing ordinary activities as normally as possible despite pain.¹ There is strong evidence that this leads to better outcomes than “traditional” treatment, which includes the comment “let pain be your guide.” This may seem trivial, but the importance of psychosocial factors, especially in chronic pain, is well established.