Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor
In Reply: The many letters in
response to the Clinical Crossroads addressed 3 main issues: (1)
electrodiagnostic testing, (2) physical therapy or chiropractic
manipulation, or both, and (3) the use of colchicine.
Electrodiagnostic studies may have suggested altered nerve
function, but would not be reliable in predicting Mr S's outcome. The
issues of specificity and sensitivity must be considered to avoid
overestimating or underestimating neural involvement. Mr S did not
demonstrate any weakness on physical examination, his leg lengths were
equal, and his range of motion was normal. There was no evidence of
ongoing denervation. Regarding the pathomechanisms of leg pain, the
article by Kawakami et al1 demonstrates a lack of
correlation between axon histology and function. Further work is
needed; however, these findings are noteworthy and should be thought
about before embarking on a series of diagnostic tests in search of a
treatment. The patient did not have a foot drop and there was no
evidence of ongoing muscle dysfunction.
Weinstein JN. Clinical Crossroads: A 45-Year-Old Man With Low Back Pain—Reply. JAMA. 1999;281(10):893–895. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-10-jac90000
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: