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Low-Back Pain and Intravenous Drug Abusers

Arch Intern Med. 1990;150(5):1125-1128. doi:10.1001/archinte.1990.00390170147041.
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To the Editor.—The role of plain roentgenography for low-back pain was discussed in a recent article1 and in an accompanying editorial2 that appeared in the January 1989 issue of the Archives. On the basis of statistical associations, the study investigators used older age (>50 years), long duration of symptoms, reflex asymmetry, and point vertebral tenderness as the criteria for obtaining plain roentgenograms in patients with low-back pain. The study population of 471 patients included only 25 (53%) drug or alcohol abusers, and there were no cases of infection diagnosed by plain roentgenogram. In intravenous drug abusers, all four criteria highlighted in the study may be absent, and yet a serious, but potentially curable, infection may exist. At the Detroit (Mich) Medical Center, during 1980-1985, we encountered 14 intravenous drug abusers with spinal epidural abscess.3 All 14 were under 35 years of age. Back pain was present


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