Your excellent review of back pain (WDDTY Vol 10, No. 5) prompts this letter. You did not mention the use of heated (80¡ Fahrenheit) pools such as those provided by the YMCA, founded by the English around the 1840s, and the use of water aerobics. The recommendation is three sessions a week of 45 minutes.

My second recommendation to patients agrees with yours meditation.

As a psychiatrist I ask in the opening visit how many of one's family and friends have died in the last two years. As the answer is typically six, I realise that life and death situations are causing the health problems of the patient.

In addition I am very sensitive to the relations of the male to women and support the relationships by increasing male self mastery through increasing work abilities.

Separations and divorce cause an increase in back pain.

As I use figure drawings to pinpoint unconsciously drawn pain problems, I am quite aware that more than one area of the body is in pain.

The development of heart complications is magnified by the development of arthritis, diabetes and hypertension. This seems to point to an immune system problem as the ultimate cause of back pain.

I also think a sexually transmitted disease is often involved in the muscle spasm process. The presence of chlymydia in heart muscle has been noted. I have the suspicion that the muscle spasm noted by so many doctors is virally or bacterially caused in a group which has been more sexually active with a large number of women.

However, the virus is relatively dormant until injury. At that point, where one may expect acute pain improvement in two to three months, the chronic pain patterns set in.

The virus is now activated and a major problem.

The antiviral and antibacterial qualities of various alternative medicines, such as garlic, St John's wort and others are vital medications in my armamentarium to treat back pain.

Leonard R Friendman, MD Boston, Mass.....