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As a group, pain medicine clinicians often fail to help back pain patients. The failures are constant reminders that we lack a cohesive theory of the etiology and treatment of clinical pain. Until recently, we each parochially practiced our own specialized approach in a vacuum, without the need to justify why we did things our way. The current reimbursement crisis is changing things. The stampede is on for outcomes assessment to establish the value (outcome/cost) of interventions. But how you arrive at 'outcome' is crucial. The clinicians' ability to practice the way they want will hinge on showing that their 'customers' accept the value of the service. There are several outcomes measures in use today. But so far none is a comprehensive, globally accepted instrument. The American Academy of Pain Medicine's Uniform Outcomes Measures Committee (UOMC), of which I am Chairman, has been working on a standardized outcomes assessment tool for 6 years. We are now field testing a prototype. The lead article summarizes the UOMCs work. The Committee's work is more difficult because pain medicine is a multidisciplinary field. Team members often hold diametrically opposing views on the etiology and treatment of similar symptoms. Opposing views were never more clear than in the creation of this edition. Some articles were close to heresy, even stupidity in the opinions of some reviewers. To encompass this broad range of opinion, we chose a point-counterpoint format. Throughout, we incorporated the idea that muscles are often overlooked or underemphasized as a cause of back pain. This issue is a tribute to Hans Kraus, MD who died in March of 1996 at the age of 90. He led an extraordinary life: world-renowned physician, author, and mountain climber. Kraus provided the spark to President Eisenhower that ignited the President's Council on Physical Fitness in 1955. He reported on the failure of 50% of American children vs. 4% of European children to pass a basic test of postural trunk muscle strength and flexibility. He returned to the White House in 1963 when Eugene Cohen, MD, President Kennedy's endocrinologist, requested Kraus to consult in the treatment of Kennedy'S back pain. Kennedy had been getting up to six 'trigger point injections' a day without any lasting relief of his pain. Kennedy had two failed laminectomies and had suffered an acute strain when he planted a tree with Prime Minister Trudeau in Canada in early 1963.

Technological advance amidst humanistic decline: Ignoring muscle evaluation and treatment in the modern age of medicine