The gap between what we know and what we do in the clinic

Low back pain care is presented as an area where clinical practice often fails to match the evidence. The lecture outlines major gaps between guidelines and real-world treatment: patients are frequently managed in emergency departments instead of primary care, receive little structured education, are advised to rest rather than stay active, undergo unnecessary imaging, and are commonly given medications, especially opioids, ahead of recommended non-drug approaches. It also highlights overuse of ineffective modalities, limited use of exercise for chronic pain, and poor attention to psychosocial factors. Examples from high-, middle-, and low-income countries show that these problems are widespread rather than confined to one health system. The causes described include misconceptions among patients and clinicians, financially driven healthcare structures, fragmented policy, and professional training that remains too biomedical and too isolated across disciplines. The lecture also covers practical solutions: better interdisciplinary education, public health campaigns, changes to referral and imaging systems, integrated work-disability prevention, and stratified care. The overall message is that policy reform, stronger incentives for evidence-based care, and greater research investment are essential to reduce disability from low back pain.