Fail Diagnosis = Fail Treatment

The recent article, “What Works for Low Back Pain? New Study Suggests Not Much," draws attention to a critical flaw in the current approach to managing low back pain: the overreliance on nonspecific, generalized treatment strategies in the absence of a proper diagnosis.

If a clinician cannot identify the cause of low back pain, then it’s no surprise that nonspecific treatments would fail to outperform placebo. Pain management cannot be effectively standardized when the pain generator is unknown. This study doesn’t reflect the failure of all nonsurgical interventions—it reflects the limitations of treating back pain without diagnostic clarity.

Spine-trained professionals, including interventional pain, physiatrists and spine surgeons, are equipped with the tools and expertise to:
- Perform detailed physical exams
- Establish a differential diagnosis
- Use targeted diagnostic image-guided blocks, to localize the source of pain
- Develop individualized, evidence-based treatment plans tailored to the patient’s pathology

By contrast, non-spine specialists applying generalized protocols are likely missing the root of the issue entirely. This can result in ineffective treatment, prolonged disability, and escalating healthcare costs.

A better approach would be a physiatry-first model-leveraging the diagnostic and clinical strengths of physical medicine & rehabilitation physicians to assess musculoskeletal and spine pain at the front line. This model emphasizes:
- Functional assessment
- Nonoperative expertise
- Interventional diagnostics when needed
- Coordination of care between conservative and surgical pathways

Instead of viewing this study as proof that nothing works, we should interpret it as a call to elevate the standard of diagnostic care for back pain. When the diagnosis is wrong—or missing—the treatment is destined to fail.