Clear Diagnosis and Therapy Are Possible

The authors assume that there exists something called “unspecific” back pain, the causes of which are all but unidentifiable (1). If there is any such thing at all as back pain with no somatic basis, it is caused by somatoform or other mental disturbances and is therefore not unspecific. However, diagnostic and therapeutic nihilism should have been finally laid to rest since the publication of DePalma’;s 2015 article (2), if not before.

Appropriate diagnostic tools reveal a breakdown approximately as follows: circa 40% of back pain is discogenic, 30% is caused by facet joint problems, and 20% by the sacroiliac joint.

Large case numbers (3) confirm the validity of the methods used, and even problem cases such as postspondylodesis syndromes can be assigned a diagnosis (4). In other words, clear diagnosis and therapy are very much possible.

I also find the periods used to classify pain as acute or subacute substantially too long, considering how swift chronification is. Intervention in such cases can shorten illness considerably, leading to correspondingly significant savings in direct and indirect costs of illness.

Casser et al. also fail to mention prescription of coanalgesics such as antidepressants or anticonvulsants. However, this is a pathophysiologically justified measure and has the side effect of also being able to treat concomitant depression and anxiety.