On the nature of illness and disability: an editorial

Issues underlying the rapid increase in assignment of disability to nonspecific low back pain are addressed. The central point of the discussion is that the healthcare system relies too exclusively on a biomedical perspective on pain and illness while failing to consider adequately environmental influences on symptom behavior and care seeking. Specific medical conditions with pathoanatomic findings observed are distinguished from nonspecific conditions in which those are lacking or only inferred. A biomedical model often suffices with specific conditions but, inherently, nonspecific conditions implicate the environment and social feedback. Impairment usually is defined in terms of biomedical issues. Disability, however, although often originating with impairment, is subject to major influence by patient effort and other considerations implicating the environment. In light of these issues in addition to reconsidering disability policy, attention also is directed to implications for the physician's role in implicitly encouraging patient perceptions of suffering as related inevitably to assumed underlying pathoanatomic factors.