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Low back pain is a burden in health policy and medical care. One of the main problems in that field comes from the fact that a minor part of all patients developchronic pain; those claiming for the main part of all costs. The transition from acute to chronic pain is dominated by psychological factors and there is a strong need to identify them at a very early stage of the illness. Concerning diagnostic procedures it is at first necessary to eliminate red flags. Afterwards, treatment is dominated by motivating the patients to intensify their daily activities and to inform them about the harmless nature of non-specific back pain. In case of chronic pain syndromes there is a strong need for interdisciplinary procedures in diagnosis and multiprofessional treatment. Multimodal treatment should be modelled on the concept of functional restoration.

Aim of the Study: Treatment of chronic low back pain is a difficult problem and usually of low effectiveness. Aim of the study was to analyse the effectiveness of a multimodal treatment procedure., Methods: From the basis of functional restoration concepts primarily established in the USA we conceptualized a treatment program which initially was funded by the German ministry of research. Over the years the regimen was modified in several respects (programs of different intensity). From 1990 to 2000 762 patients were treated in this way with one-year follow-up examination., Results: Patients who were off work had significant differences in psychosocial and pain-related variables in comparison to those patients who were still working. Treatment procedures were in general very effective, although a modification of the program with less treatment (no work-hardening) failed in repeating the same effects. Pain intensity, disability, amount of depression and psychological distress improved significantly as well as work capability and use of the health care system. Nearly all results were seen to stabilize at the 12-month evaluation., Discussion: Functional restoration programs for treatment of chronic low back pain have demonstrated effectiveness in several countries. By early use of these programs the high amount of costs due to back pain disability may be consequently reduced. Up to now in Germany these concepts are not well-known and insurance companies as well as the health system do not yet acknowledge them.

Back pain is a common disease causing tremendous costs for treatment, rehabilitation, litigation and work-loss. The reasons for back pain vary considerably and are often not clear. The effectiveness of current treatment concepts like epidural injection of steroids, blocks of facet joints, transcutaneous electrical nerve stimulation and antidepressants has not been proven. In accordance with literature, only multimodal concepts of treatment seem to be more successful as they consider somatic, psychosocial, and sports physiological aspects.