The Journal of the American Board of Family Practice 18:152 (2005)
© 2005 American Board of Family Practice
Author’s Reply
Peter A. Rives, MD, FAAFP and
Alan B. Douglass, MD, FAAFP
Pain Care Institute
Owensboro, Kentucky
Family Practice Residency Program
Middlesex Hospital
Middletown, Connecticut
To the Editor: Our article was designed as an evidence-based review of the diagnosis and management of low back pain in the primary care medical setting, with emphasis on treatments supported by level A and B evidence.
In response to the main points in Dr. Jones’ letter:
- We believe a robust body of medical evidence supports the prompt resolution of most episodes of acute low back pain. Although the exact percentage of patients whose symptoms resolve within a given period of time will continue to be debated, we do not believe that the recent literature quoted by Dr. Jones substantially changes our assertion.
- As we point out in our article, physical modalities play an important role in the treatment of low back pain. However, we are unaware of any high-quality evidence supporting Dr. Jones’ assertion that "effective and timely treatment is essential to preventing chronicity" or that recurrent episodes of low back pain necessarily lead to permanent neurological changes.
- Dr. Jones is correct in pointing out that a precise anatomic pain generator is not always found in patients with low back pain. We do not, implicitly or otherwise, advocate an aggressive search in every patient. However, in our view, ignoring the possible presence of a treatable lesion in deference to functional assessment is not in the best interest of patients.
- In our opinion, the literature strongly supports the view that psychosocial variables play a significant role in the persistence of low back symptoms. These issues were explored in depth within our article.
In summary, although we acknowledge Dr. Jones’ points of view, we stand by the approach to diagnosis and treatment of low back pain outlined in our article.
