How can you tell if a second bout of back pain is really just part of the first episode? I've had three rounds of back pain. Each one is a little different but the insurance company wants to say it's all one problem. There's a limit on how much treatment they will pay for each "episode."

Studies show over and over that people who have an episode of back pain are likely to have back pain again. A recent study from Sweden reports about half of all patients will seek out health care up to five years later.

You're asking if a second or third episode of back pain is a flare up of the same problem or a new attack. Your primary care provider (doctor, chiropractor, physiotherapist) is the one who will make this decision. It's usually based on what caused the symptoms and results of your physical examination.

So while it's true that a previous history of back pain puts you at increased risk for more back pain in the future, each bout of back pain must be examined and classified according to its presentation. You'll need to ask your doctor or therapist to submit proper documentation to the insurance company to prove this.

Paul Enthoven, RPT, et al. Clinical Course in Patients Seeking Primary Care for Back or Neck Pain: A Prospective 5-Year Follow-Up of Outcome and Health Care Consumption with Subgroup Analysis. In Spine. November 1, 2004. Vol. 29. No. 21. Pp. 2458-2465.