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December 27, 1995

A 50-Year-Old Woman With Disabling Spinal Stenosis

JAMA. 1995;274(24):1949-1954. doi:10.1001/jama.1995.03530240059042

Dr Delbanco:  Miss W is a 50-year-old woman who has a long history of low back pain. Divorced, she lives in an apartment by herself and works as a medical technician in a community-based doctor's office. She is insured through a large not-for-profit managed care organization.At 4 years of age, Miss W fell off a horse, but she did not have subsequent problems until 18 years of age when she experienced low back pain. Since then, she has had intermittent pain and multiple therapeutic recommendations from chiropractors, orthopedists, and a neurosurgeon in addition to her primary care doctor. At times, she has been on prolonged periods of bed rest and has had to miss work. Approximately 8 years ago, Miss W developed symptoms of fibromyalgia with generalized pain focused on her knees, bunions, elbows, wrists, shoulders, and pelvic region. She has been treated with multiple nonsteroidal anti-inflammatory agents (NSAIDs),

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