• Julia S Miller and Mark A Pinnington.
• R&D Department, Halton Primary Care Trust, Moston Lodge, Countess of Chester Health Park, Liverpool Road, Chester, UK. julia.miller@cahc-tr.nwest.nhs.uk
• Eur J Gen Pract. 2003 Mar 1; 9 (1): 393-9.

BackgroundLow back pain is a common condition in general practice and represents a significant part of a general practitioner's workload. However, despite guidelines, back pain still presents considerable challenges to clinicians.ObjectiveTo explore the perceptions and declared behaviour of UK general practitioners in relation to patients with low back pain.MethodA qualitative design was used, involving semi-structured interviews with 17 GPs in the North of England. Interviews were transcribed verbatim and analysed using qualitative thematic analysis.ResultsTwo major themes emerged from the data relating to approaches to and perceptions of low back pain. A dichotomy emerged, where GPs describe their approach to what they know to be a straightforward consultation where most patients recover, and the frustration they experience when patients do not. Although GPs are using a simple bio-mechanistic approach to low back pain, they also operate a method of categorising patients, which involves identifying real and pseudo patients. When confronted with 'challenging' cases, that is those who do not recover, most GPs feel isolated and poorly prepared.ConclusionGPs adopt a bio-mechanistic approach to LBP which appears to work well for the majority of patients, as the natural history of low back pain dictates that most patients will recover. However, this approach to low back pain fails at the margins and this is evident by the significant minority of persistent sufferers and the GP's reaction to them. Expanding patient-centredness to explore psychological and social dimensions in relation to low back pain presents an ongoing challenge in general practice.

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