Mark has been so kind to share his thought regarding diagnosis and treatment of spinal pain. Especially the subject of pathoanatomy or what is often referred to as the bio part of the biopsychosocial model.

This was a very objective and good chat where we go in deep on the following subjects;

We start out by taking a look at Marks recent paper ( Reconsidering non-specific low back pain: Where to from here?) and highlight that little attention / research into pathoanatomic diagnosis has been made. And combines this we an earlier paper from 2011 (Discussion paper: what happened to the ‘bio’ in the bio-psycho-social model of low back pain?).

We then jump into some very used papers or at least one  of them cause the other one seems neglected or for some reason less interesting  and those are the papers by Brinjikji et al 2015, Systematic literature review of imaging features of spinal degeneration in asymptomatic populations.  and  MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis.  These papers are excellent for clinicians and researchers however it is my understanding that they to some extent mainly is used for telling people that their imaging findings are normal which, but I believe there is more to be said from those papers.

Then we discuss the ability  (reliability and validity) to use pathoanaomic diagnosis in the clinic. A practice that the current literature suggest is not posiible , however depsite that some people in the health industry seem to neglect that which I believe has several limitations and might even be harmfull.  Marks paper from 2007 looks into this matter on abillity to make a pathoanatomic diagnosis (Hancock, M., Maher, C., Latimer, J. et al. Systematic review of tests to identify the disc, SIJ or facet joint as the source of low back pain. Eur Spine J 16, 1539–1550 (2007). https://doi.org/10.1007/s00586-007-0391-1)

As always thanks for listening
Brian