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To the Editor: In his Editorial that accompanied the study by Dr Jarvik and colleagues,¹ Dr Hadler² emphasized the importance of psychosocial factors and the value of enhancing coping skills of patients with regional back pain. Although I agree with this approach, I fear his conclusion may lead to neglect of other etiologic factors. Hadler stated, "For regional back pain, no theory has withstood scientific testing." However, failures to withstand scientific testing may reflect limited understanding of complex interactions between multiple factors leading to back pain.

For example, I remember the days when older patients immobilized by degenerative bone and joint diseases were expected to cope with their pain and debilities by suffering in silence. Today, their middle-aged and older descendants play golf, tennis, and even teach yoga, thanks to hip and/or knee replacements. We clearly need enhanced understanding of the pathophysiology of back pain.

I am troubled by Hadler's . . . [Full Text of this Article]

Lissy Jarvik, MD, PhD
Department of Psychiatry and Biobehavioral Sciences
University of California, Los Angeles

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