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Invited Commentary
July 9, 2012

Are the Top 5 Recommendations Enough to Improve Clinical Practice?Comment on “Application of ‘Less Is More’ to Low Back Pain”

Author Affiliations

Author Affiliation: ABIM Foundation, Philadelphia, Pennsylvania.

Arch Intern Med. 2012;172(13):1020-1022. doi:10.1001/archinternmed.2012.1943

I am not a physician, but I have relevant patient experience. For the past 20 years, I have had no significant back pain. Before that, I had a bad back for 20 years, with almost daily sciatica pain and frequent episodes of a misaligned spine, with crippling muscle spasms. Seeking relief, I visited neurologists, orthopedists, chiropractors, acupuncturists, physical therapists, and finally a physiatrist. The cure came from the mind-body connections offered by my physiatrist. My experience is that curing back pain is complex and that testing often reinforces a bioskeletal problem when there is frequently a large psychological component involved. Is this a case of testing preventing a cure?1 The authors of “Application of ‘Less Is More’ to Low Back Pain”2 in this issue of the Archives refer to this phenomenon as patient “labeling.”

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