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Controversies in Internal Medicine |

Rebuttal by Dr Abraham

Irwin Abraham, MD
Arch Intern Med. 2002;162(13):1447. doi:10.1001/archinte.162.13.1447.
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ACUTE LBP is indeed often benign. However, we all know that some patients with LBP will have continuing disability after 1 year. A percentage will eventually have chronic LBP and remain unable to work.

It is time to change our view to a perspective that truly utilizes scientific medicine. By this we intend critical analysis of available and new evidence. We visualize the learning of new patterns of low back dysfunction or disease that previously could not be appreciated and therefore not treated. Physicians and others have accomplished this in many other areas of medicine. In the early 1970s, asthma was defined as extrinsic and intrinsic. Extrinsic meant allergic in origin. Intrinsic was a code word for a nonphysiologic psychogenic origin. This definition changed with new knowledge. At the same time, angina pectoris and myocardial infarction were understood as being different aspects of the same pathophysiologic phenomenon. We know now that angina pectoris and myocardial infarction have very different etiologies. Duodenal ulcers were thought to be highly related to psychological stress. Now we know that a bacterium causes most duodenal ulcers.

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