Author Affiliation: ABIM Foundation, Philadelphia, Pennsylvania.
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.”
Daniel B. Wolfson. Are the Top 5 Recommendations Enough to Improve Clinical Practice?Comment on “Application of ‘Less Is More’ to Low Back Pain”. Arch Intern Med. 2012;172(13):1020–1022. doi:10.1001/archinternmed.2012.1943