LAUSR

The January issue contained three papers that complemented each other. The paper by Stochkendahl et al. [1] concerning National Clinical Guidelines for the non-surgical treatment of recent low back pain or lumbar radiculopathy from Denmark, but very much reflecting the NICE UK Guidelines. What was surprizing was the lack of evidence for those guidelines, despite extensive reviews of the literature. They advised staying active, quoting two studies which showed a small statistically significant effect. They advised education, but restricted it to patients who were motivated and based on patient centred dialogue. They felt that the evidence did not support early imaging and rejected this on the basis there was radiation (not so with MRI scans) and likelihood that the clinician would often label patients with a diagnosis that alarmed them, surely a failure of communication. They also suggested that the use of pain medication, both for back pain and radiculography was unproven, which I find difficult to accept and must question the evidence on which this conclusion was based. The paper by Zehra et al. [2] concerning our understanding of end plate changes was a very comprehensive review of the multitude of endplate changes, very beautifully illustrated, yet a marked difference in opinion amongst very experienced surgeons and radiologists as to their clinical significance. In the circumstances as clinicians themselves are uncertain about the significance of changes, explaining them to patients represents a difficulty. The editorial by Gunzburg [3], concerning “Structural vertebral endplate nomenclature and etiology: a study by the ISSLS Spinal Phenotype Focus Group”, emphasized the significance of this paper and the need for further research. However, the paper by Karran et al. [4] dealt with the reassuring value of imaging to patients, if careful thought is given to how this is done. The authors developed a specific psycho-education programme and demonstrated its value to patients. They made a strong case of availability of imaging to primary care providers. The paper in the March issue by Morris et al. [5] dealt with the value of osteopathic treatment of chronic back pain, acute back pain, neck pain and other varieties of axial pain. Using data derived from the Spine Tango registry, although it provided a wealth of statistical figures, obscured by the use of acronyms it relied on patient satisfaction in the main * Robert C. Mulholland [email protected]