Dr Johnston raises important concerns about the methodology of existing treatment studies of chronic low back discomfort. He suggests that antidepressants may be particularly effective in some subgroups of patients, but not effective at all in others. While all of the 9 studies we discussed included patients with multiple diagnoses for low back discomfort, 8 examined or imaged patients prior to enrollment. In their exclusion criteria or results section, they did not include patients with malignancy, structural disorders requiring surgery, or pain from nonrelated systemic disorders outside the back area.1
Salerno SM, Jackson JL. Chronic Back Pain: A Symptom in Search of a Diagnosis—Reply. Arch Intern Med. 2002;162(11):1310–1311. doi:
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