Dr Coodley appropriately points out the contribution of psychosocial factors to the etiology and course of low-back pain. The usual distinction between "psychogenic" and "organic" pain is certainly artificial, and most patients have elements of both.1 Psychosocial factors may certainly affect the physician's choice of therapy and the patient's response to treatment, but such information is rarely collected in clinical trials. This is another argument for the need to provide better description of the patients who are entered into therapeutic studies.We also apparently agree that psychosocial function may be as important as physiological function in assessing therapeutic results. Although such outcomes are notoriously difficult to measure, clinical expertise and social science methodology are being fused to create new questionnaire instruments for assessing both physical and psychosocial function. We have tested one of these instruments among patients with low-back pain2 and find it promising for both
Deyo RA. Low-Back Pain-Reply. JAMA. 1984;251(12):1554. doi:10.1001/jama.1984.03340360021013
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