Complex issues

As a physician practising emergency medicine, sports medicine, and chronic pain management, I deal with patients with back pain on a daily basis. Although the Cheng et al1 study suggests good criteria to help decision making when it comes to referral, it has more limitations than cited. Being a retrospective analysis evaluating the surgical route versus non-surgical route, the study does not look at outcomes of that particular path. Did patients undergoing surgery believe it ended with a successful outcome? Did the non-surgical patients perform worse on the validated pain and quality-of-life questionnaire? Did any of the non-surgical patients seek second opinions and were any of them operated on by another surgeon? If that scenario occurred, were the results successful as per their outcome measures?

Back pain and imaging are so complex, and I find it difficult to counsel patients as to their best treatment options. This is without mentioning the paucity of dedicated spine surgeons who can keep ahead of the referral piles.

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