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BackPage Online, February 2017

doi: 10.1097/01.BACK.0000512224.61453.41
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Gout: Don't Forget It Can Affect the Spine

Gout is the most common form of inflammatory arthritis among adult men—and also affects women. Its most common presentation is excruciating pain, inflammation and swelling in and around the big toe. It also commonly affects the insteps, ankles, heels, knees, wrists, fingers and elbows.

But many healthcare providers forget that gout can also attack multiple joints in the spine—and produce debilitating back and neck pain. Since most healthcare providers don't think of gout as being in the realm of back pain causes, it may be overlooked as a diagnosis with a subsequent delay in treatment. This can lead to unnecessary suffering and spinal damage—since gout is treatable with anti-inflammatory treatments and dietary therapy.

Here is a link to a review of gout affecting the spine based on 68 published studies.

Consumer Reports on Chiropractic Care, Massage and Acupuncture

The consumer product review publication Consumer Reports has published a series of articles on the management of low back pain, in the wake of a large grant from the US Department of Justice. The latest, which appeared in the Washington Post, looked at the pros and cons of chiropractic care, massage, and acupuncture for low back and neck pain—giving qualified endorsement to all three modes of back care.

Here is a link to the Washington Post article:

World Health Organization Disowns the Controversial FRAX Tool for Identifying People at Risk of Osteoporotic Fractures

The FRAX tool is a widely publicized but controversial screening tool for identifying men and women at risk of low bone density and/or osteoporotic fractures—and determining who might benefit from drug treatment.

Numerous proponents have boasted that the FRAX tool has been endorsed by the World Health Organization (WHO). However, several members of the WHO Guideline Review Committee recently disowned the tool, stipulating that WHO has no formal position on its value or utility. This is a major blow, and a well-deserved one, for the FRAX screening method.

“By this statement, the World Health Organization wishes to make clear that the FRAX® tool to evaluate fracture risks of patients is not a “WHO tool” and has not been developed, endorsed, evaluated or validated by WHO, notwithstanding any public statements and claims to that effect,” according to WHO Guidelines Review Committee chairman Nathan Ford and colleagues.

Here is the link to the full editorial:

And here is a link to a commentary on this controversy at In that report, Drug Policy researcher Alan Cassels offered some background on the FRAX tool, which has been heavily criticized for medicalizing normal levels of bone density in aging men and women and for being a “drug marketing tool:”

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