LAUSR

I read with great interest the article of Eloqayli et al. in a recent issue of the Journal. The authors performed a case control study on 108 patients and concluded that Iron and Vitamin D deficiency should be considered as two modifiable risks for neck pain. The authors should be congratulated for performing a welldesigned study in an important topic (e.g. spine pain) in neurosurgical patients. In addition, the current emphasis on the need to reduce the use of opioids by addressing modifiable risks and using multimodal strategies on chronic pain patients makes the topic very relevant. Although the study of Eloqayli et al. was well conducted, there are some questions regarding the study that need to be clarified by the authors. It is unclear if they adjusted their model for innumerous risk factors for the development of chronic pain (e.g. prior trauma, exercise, gender, age, comorbidities, smoking). A simple propensity matching analysis would account for covariate imbalances between the groups. In addition, patients with chronic pain have high rates of depression when compared to patients without chronic pain. It is possible that chronic pain patients had poor appetite due to depression, resulting in a lower intake of Iron and Vitamin D when compared to patients without chronic pain. I would welcome comments to address the aforementioned issues as they were not discussed by the authors. This would further support the findings of this important clinical study. Disclosure statement