There are several shortcomings to this study that must be addressed to appreciate the implications of these results. First, our findings were obtained in a select group of individuals faced with unique circumstances. Hence, generalizing them to civilians and/or nondeployed soldiers should be done with caution. Second, though outcomes and diagnoses were recorded prospectively, no specific set of inclusion and exclusion criteria were used, and many variables known to influence outcomes were absent from medical records. Therefore, we could not control for comorbidities (eg, inadequate coping mechanisms, duration and intensity of pain, functional limitations, fear-avoidance behavior) or rule out other confounding factors (eg, divorce, poor relationships with colleagues) that might have affected outcome.32- 34 Third, because only a single diagnosis can be annotated in the database, the numbers presented herein may underestimate the true burden of back pain during wartime. Fourth, the method for assessing psychopathologic conditions was categorical (ie, yes or no) and did not account for severity and causation, which could have weakened the association found between psychopathologic conditions and outcomes. Fifth, the method used to select these service members (eg, those already evacuated to Germany) likely skewed the sample to include those at highest risk for a negative outcome. As alluded to earlier, previous analyses have demonstrated that the further an evacuee is treated from their home station, the lower the likelihood they will return to their unit.3,10 Possible reasons for this include expectations of both health care providers and service members (ie, the “default” disposition at a combat support hospital is to return a soldier to their unit, whereas in Germany it is further evacuation), a psychological “severing” of the strong bonds with their comrades, and tacit and explicit wishes expressed by service members and their commanders (ie, a soldier who is motivated to remain “in theater” and one whose commander deems it to be mission essential to remain “in theater” is less likely to make it to Germany). Hence, these findings should not be extrapolated to individuals with back pain treated “in theater.” Finally, since a majority of the clinical variables were examined post hoc, other potential flaws include those inherent in any retrospective analysis, including a limited ability to accurately assess potential predictors of outcome measures.