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—I appreciate but take issue with the concerns raised by Dr Levy. In the Clinical Crossroads article, spinal stenosis was highlighted, but the discussion included many nonoperative options, though perhaps not in great detail. The treatment recommended was tempered by the fact that the 50-year-old patient did not have clear, unequivocal findings. For years, prior to obtaining the concurrent diagnosis of spinal stenosis, she had been treated for fibromyalgia with anti-inflammatory agents, antidepressants, analgesics, and multiple other therapeutic modalities, including recommendations for exercise. The authors of both letters have given examples of treatment options for this patient, including dosages of medications, therapeutic modalities, worksite assessment, and psychiatric evaluation and treatment. I strongly endorse these recommendations, as I alluded to in the discussion. It is exactly because of the vagaries of not only the diagnosis, but also the treatment in a patient such as this that my recommendation does
Garfin SR. A 50-Year-Old Woman With Spinal Stenosis-Reply. JAMA. 1996;275(18):1401-1402. doi:10.1001/jama.1996.03530420028027