OBJECTIVES: Back pain has a considerable impact on HRQoL, even with new medications, treatments and guidelines the degree of suffering for patients is high. The objective was to compare HRQoL for patients with back pain in Germany for three different treatment groups (guideline-, non-guideline- and self-treatment-group). METHODS: Patients were consecutively recruited by physicians in general practice (n=54) in 2005. Patients were categorized into the three groups according to pre-specified algorithms. All groups completed the generic SF-36, and the disease specific FFbH, von Korff Index and PHQ-D questionnaires. In addition, a retrospective chart review was conducted. HRQoL data was compared between the groups. RESULTS: A total of 145 patients took part in this study (n=29 guideline-group, 44 non-guideline-group, 72 with self-treatment). Patients in the self-treatment-group were younger than patients in guideline- or non-guideline-group (49.8 vs. 59.4 vs 57. 4 years, p=0.0021). The groups did not differ significantly in gender or other socio-demographic characteristics. The von Korff Index was lowest (i.e. poorer) in the self-treatment-group and highest in the guideline-group (p=0.0077). Regarding SF-36, patients in the guideline-group had the lowest physical (30.2±8.5) and mental (41.2±13.5) component scores, only the differences regarding physical component were statistically significant between the groups (p<0.0001), those regarding mental component were not (p=0.2875). Regarding PHQ-D items, the groups did not differ in frequency of major depressive and other depressive symptoms. The guideline-group had significantly higher burden of somatoform symptoms compared to the other two groups (p=0.0219). The self-treatment-group had the highest FFbH-R total score (67.7±21.5) compared to other two groups (p=0.0056). CONCLUSION: From the here collected data, it seems that patients who are treated according to guidelines have reached a higher degree of suffering (poorer HRQoL) compared to those patients with either treated without guidelines and/or treat themselves. Further research is warranted to confirm our findings.