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The way people with back pain cope may also be influenced by how society is organized. For instance, back pain and associated disability can be very hard to measure. In a health care system which looks for unambiguous solutions, this can lead health care professionals, insurers and employers to treat people with back problems as malingerers, or, at the other extreme, to view them as completely disabled.
"We need to be sure our health policies are helping to prevent disability and not contributing to it in subtle ways," Dr. Guzmán says. "This is an area that requires further research."
While chronic disabling back pain is often an intractable problem, multidisciplinary interventions can be successful in getting many people with back pain better. In a review of major studies of people with disabling lower back pain, Dr. Guzmán and his colleagues found intensive multidisciplinary rehabilitation can measurably reduce pain and improve function.
Dr. Guzmán has been involved in research in rheumatology (the branch of medicine specializing in disorders of the muscles, joints and tendons) since medical school. "Early in my career, I became aware of the large burden of illness and burden of disability caused by back pain," he says. "It's a huge problem. Many, many people are in need of help in this area."
A busy clinician as well as a researcher, Dr. Guzmán believes practice and research complement each other. "Clinical practice is important for me because it informs my research," he says. "And, asking relevant questions not only focuses research, it helps us find better ways to help our patients."
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