{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T18:57:03Z","timestamp":1766516223952,"version":"3.48.0"},"reference-count":78,"publisher":"BMJ","issue":"6882","license":[{"start":{"date-parts":[[1993,4,3]],"date-time":"1993-04-03T00:00:00Z","timestamp":733795200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ"],"published-print":{"date-parts":[[1993,4,3]]},"abstract":"<jats:p>The studies reviewed here show that the duration and severity of individual episodes of back pain can be lessened, reducing recurrences and their cost in terms of suffering and lost work. Frank examines differential diagnosis; acute, chronic, and intractable pain; and service implications. Modern management emphasises self care, and bed rest should usually not be longer than 48 hours. A return to physical fitness and other activities, including employment, is actively encouraged. Medication has a role in facilitating these objectives. Two points are especially emphasised: strategies to manage low back pain must be long term and preventive; and the responsibility to keep fit, maintain an exercise programme, and remain relaxed so as to avoid physically stressing the spine is that of the individual, not of the professionals.<\/jats:p>","DOI":"10.1136\/bmj.306.6882.901","type":"journal-article","created":{"date-parts":[[2009,3,30]],"date-time":"2009-03-30T08:16:37Z","timestamp":1238400997000},"page":"901-909","source":"Crossref","is-referenced-by-count":102,"title":["Low back pain."],"prefix":"10.1136","volume":"306","author":[{"given":"A","family":"Frank","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1993,4,3]]},"reference":[{"key":"ref_1","article-title":"The health of the nation: a strategy for health in England","author":"Department of Health","year":"1992","unstructured":"Department of Health. 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Int Disabil Stud 1988;l0:25-8."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/0304-3959(86)90057-6","article-title":"Efficacy of electroacupuncture and TENS in the rehabilitation of chronic low back pain patients","volume":"26","author":"Lehmann, T.R.; Russell, D.W.; Spratt, K.F.; Colby, H.; Liu, Y.K.; Fairchild, M.L.","year":"1986","unstructured":"Lehmann TR, Russell DW, Spratt KF, Colby H, Liu YK, Fairchild ML, et al. Efficacy of electroacupuncture and TENS in the rehabilitation of chronic low back pain patients. Pain 1986; 26:277-90.","journal-title":"Pain"},{"key":"ref_66","first-page":"181","article-title":"The acupuncture treatment of low back pain: a randomised controlled study","volume":"8","author":"Coan, R.M.; Wong, G.; Ku, S.L.; Chan, Y.C.; Wang, L.; Ozer, F.","year":"1980","unstructured":"Coan RM, Wong G, Ku SL, Chan YC, Wang L, Ozer F, et al. The acupuncture treatment of low back pain: a randomised controlled study. 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Arch Phys Med Rehabil 1983;64:53-6.","journal-title":"Arch Phys Med Rehabil"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1763","DOI":"10.1001\/jama.1987.03400130077037","article-title":"A prospective 2 year study of functional restoration in industrial low back injury","volume":"258","author":"Mayer, T.G.; Gatchel, R.J.; Mayer, H.; Kishino, N.D.; Keeley, J.; Mooney, V.","year":"1987","unstructured":"Mayer TG, Gatchel RJ, Mayer H, Kishino ND, Keeley J, Mooney V. A prospective 2 year study of functional restoration in industrial low back injury.JAMA 1987;258:1763-7.","journal-title":"JAMA"},{"key":"ref_78","first-page":"50","article-title":"Low back pain: development and fiveyear prospective application of a computerised quality-based diagnostic and treatment protocol","volume":"1","author":"Wiesel, S.W.; Feffer, H.L.; Rothman, R.H.","year":"1988","unstructured":"Wiesel SW, Feffer HL, Rothman RH. 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