Infection in the spine might be the cause of symptoms in a group of patients with severe chronic low back pain (LBP). What about the large body of research recommending biopsychosocial management? Where have we heard a similar story before? Well, Helicobacter pylori infection as the cause of indigestion was a major challenging discovery that led to a paradigm shift in managing that condition which had hitherto been managed mainly through symptomatic and psychological approaches, and sometimes major surgery. The similarities between these stories are uncanny—not least in the challenges facing attempts to establish the clear evidence..
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