Therapeutic management of low back pain is often arbitrary and based on the caring health care professional's personal experience. Less frequently, management is based on clinical data produced by comparative investigations employing scientific methodologies in multidisciplinary units combining the skills of a rheumatologist, physiatrist, physical therapist, occupational therapist, orthopedist, social worker, psychologist and/or psychiatrist and rheumatology/rehabilitation nurses^(9,11).
The physician caring for the subject with LBP needs to precisely ascertain the stage of the disease, the presenting features and symptoms, the biomechanical changes, the severity of the referred pain, the changes of the paravertebral muscles, and the psychological consequences of the disease. Additionally, its causes should be sought as well as the disease's mode of presentation, that is, acute, recurrent, subacute or chronic. It is also important to determine the patient's acceptance of previous treatments, the degree of incapacitation for routine activities, the effects of planned exercises and the ergonomics of the patient's professional activities. The social and economical issue regarding matters of workers compensation is also a challenge because of patient simulation.
Low back pain is perhaps the best example of the shortcomings of the disease-illness paradigm as a simple model of disability⁽²⁰⁾.
Although back pain is a common cause of disability, a few cases display an anatomical abnormality accounting for the clinical findings and symptoms. Even in cases where a diagnosis of herniated disk is attained, the patient's degree of disability may show no bearing with severity of the symptoms.
Most patients with low back pain respond to a course of conservative management. However, the components of nonoperative therapy that are effective in treating and preventing low back pain continue to be debated in the literature^(4,5).
Lahad et al(15) reviewed a total of 190 papers to find 64 studies that discussed the efficacy of back and aerobic exercises, education, mechanical supports, and risk factor modification (cessation of smoking and weight reduction) for the prevention of back pain in asymptomatic individuals. Despite the fact that only a few data support

Wiliam Habib Chahade, MD, PhD
Rheumatologist.
Director, Rheumatology Department, Hospital do Servidor Público Estadual de São Paulo (HSPE). Professor of Post-Graduation in Rheumatology (FMUSP and HSPE), São Paulo, Brazil.

Linamara Rizzo Battistella, MD, PhD
Physiatrist.
Director, Rehabilitation Medicine Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP).
Professor of Discipline of Physiatry, School of Medicine, Pontifícia Universidade Católica de São Paulo, São Paulo, Brazil.

Maria Cristina Biasoli, PT
Physical therapist.
Low Back Pain Study Group, Rheumatology Department, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil.

* Este trabalho foi publicado pela Organização Mundial da Saúde (Genebra): WHO/NCD/NCM/99.1. Ehrlich, GE & Khaltaev, NG (eds.) - Low back pain initiative. The World Health Organization. Department of Noncommunicable Disease Management. Geneva, 1999. p.32-47.
br>Autorizada a publicação apenas de acordo com o original (em inglês).


its beneficial role, exercises that strengthen back and abdominal muscles is the intervention associated with a decreased rate in the frequency and duration of low back pain^(8,32). Minimal evidence exists for education, and there are insufficient data confirming efficacy of mechanical supports and there is no evidence for risk factor modification as a mean of preventing low back pain. The generalization of these data to the general population must be made with caution because the published studies were conducted in the workplace.
In this paper, we discuss some therapeutical alternatives and rehabilitation programs for idiopathic low back pain and for those cases of low back pain caused by biomechanical imbalance^(9,11).

Rest
A two to three-day bed rest is recommended for mild to moderate cases whereas a period of 1 to 2 weeks of rest can be recommended for cases where radiculopathy is present. It is likely that a bed rest period of over three days does not decrease the disability rate. Rest should