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"Spinal Pain"; A Symptom Not a Diagnosis
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Myron M. LaBan, M.D. William Beaumont Hospital, Royal Oak, MI 48073, Department of PM&R
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myjoy{at}comcast.net Myron M. LaBan
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Myron M. LaBan, M.D., FACP, FAAPM&R Department of Physical Medicine & Rehabilitation William Beaumont Hospital 3601 W. Thirteen Mile Road Royal Oak, MI 48073 Phone: 248-898-0162 Fax: 248-642-2483 Email: myjoy@comcast.net Key Words: Cervical spine pain, Lumbar spinal pain, Manipulation The Editor Annals of Internal Medicine 190 N. Independence Mall West Philadelphia, PA 19106-1572, USA “Spinal Pain”; A Symptom Not a Diagnosis To the Editor: As a physiatrist honored over 30 years ago by my internist colleague’s nomination to the American College of Physicians, I have since looked forward to receiving my monthly issues of the Annals of Internal Medicine. As a past President of the American Academy of Physical Medicine & Rehabilitation and subsequently its liaison to the ACP, I have on a number of occasions privately called attention to the Annal’s apparent disturbing editorial policy which continues to treat the issue of spinal pain, i.e., both lumbosacral and cervical, as a generic disease entity rather than more appropriately as a symptomatic complaint. Two articles appearing in the December 2004 issue of the Archives the initial on “neck pain”1 and the later on “low back pain”2 are again but two examples of a continuing cavalier treatment of this complex and challenging entity which in addition to the health issue itself also has significant societal and economic consequences. The Editors of the Annals would undoubtedly be more discriminating if called upon to publish an article on “stomach pain” and/or “heartburn”! Although the most frequent cause of spinal pain remains that of degenerative disease and its associated osteoarthritic involvement of the zygapophyseal joints, among other significant etiologies are herniated discs, spinal stenosis, occult spinal and paraspinal metastasis3 as well as pathomechanical vascular dysfunction, i.e., aneurysms and cardiomyopathies.4 A failure to discriminate in all treatment series as to the etiology of spinal pain should in this otherwise quality journal preclude publication. To continue to do otherwise, does a disservice to its readers as well as continuing to risk the otherwise well-earned reputation of the Annals. As a caveat after five days of “spinal pain” manipulation has been demonstrated to be no better than conventional physical therapy!5 References 1.White P, Lewith G, Prescott P, Conway J. Acupuncture versus placebo for the treatment of chronic mechanical neck pain. Ann Intern Med 2004;141:911-919. 2.Childs JD, Fritz JM, Flynn TW, Irrgang JJ, Johnson KK, Majkowski GR, Delitto A. A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study. Ann Intern Med 2004;141:920-28. 3.LaBan MM, Wilkins JCS, Szappanyos B, Shetty AN, Wang A-M. Paravertebral plexus of veins (Batson’s) the potential route of paravertebral muscle metastasis as imaged by magnetic venous angiography (MVA). Am J Phys Med Rehabil 1997;76:517-19. 4.LaBan MM, Wilkins JC, Wesolowski DP, Bergeon B, Szappanyos BJ. Paravertebral venous distension (Batson’s), an inciting etiological agent in lumbar radiculopathy as observed by venous angiography. Am J Phys Med Rehabil 2001;80:129-33. 5.LaBan MM, Taylor RS. Chiropractic manipulation in low back pain and the recommendations of the Agency for Health Care Policy and Research (HCPR). Letter to the Editor. Ann Internal Med 1999;130:75. Conflict of Interest:None declared |
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