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Comment & Response
April 11, 2022

Management of Chronic Low Back Pain

Author Affiliations
  • 1Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City
  • 2Spine Intervention Society, Hinsdale, Illinois
JAMA Intern Med. 2022;182(6):687. doi:10.1001/jamainternmed.2022.0745

To the Editor We commend Dr Cohen’s effort to summarize the evidence regarding chronic low back pain (CLBP)1 management given the complexities of diagnosing and treating this symptom. Chronic low back pain potentially arises from numerous anatomical structures and may be influenced by psychosocial and occupational factors. Appropriate management requires identifying the correct pain sources and potential non-nociceptive contributions to establish an accurate diagnosis and select appropriate treatment. Many studies do not attempt to diagnose the sources of CLBP or fail to use methods recommended by practice guidelines for doing so. This leads to inclusion of a heterogeneous study population of which only a subset may have an appropriate indication for the study treatment. As such, this body of literature has substantial limitations when taken as a whole. Although the present review1 asserts a lack of evidence to support interventional treatments, it does not account for the effectiveness of various treatments based on specific diagnoses. There are numerous high-quality studies that have demonstrated excellent clinical outcomes and cost-effectiveness when patients are properly diagnosed and treated accordingly.2-4

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