I was very interested to read your article on back pain (WDDTY vol 10, no 5). Please allow me to comment, as a musculoskeletal medicine specialist, who is also an osteopath, with 27 years' experience.

Your statement that one in 12 women who have epidurals are likely to suffer long-term back pain could be misleading. Pregnancy epidurals are lumbar epidurals. Many doctors like myself do caudal epidural injections for intervertebral disc herniations and find the procedure very safe and a good adjunct to osteopathic treatment. Patients recover quickly. Lumbar epidurals are an in-patient procedure, whereas caudal epidurals are suitable for outpatients. Patients with 'slipped discs' not given the chance of caudal epidural may have an unnecessary microdisectomy operation instead.

If the patient is referred to a surgeon, surgeons do not do epidurals. Anaesthetists consider the procedure is in their field. On the other hand, very few anaesthetists understand back pain.
The British Institute of Musculo-Skeletal Medicine (BIMM) can advise patients in finding a musculoskeletal specialist. The BIMM can be telephoned on: 01923 220 999, or The London College of Osteopathic Medicine can be contacted on 017 1262 1128. - Dr B Pattinson, Richmond Upon Thames