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Four humorous pieces for the humor collection

From the New England Journal of Medicine, March 7, 1991 (Volume
324 Number 10):

To the Editor:

I wish to report the serendipitous discovery of a symptomatic
treatment for low back pain that, until now, has been
underutilized. Six months ago I evaluated a 48-year-old retired
airline pilot with a two-month history of ... [unrelated complaint
deleted]. ... he had ... and responded quickly to ... On a follow-
up visit at six months, he reported continued control of the facial
pain but described an exacerbation of his chronic, intermittent
low-grade lumbar back pain. On examination, he had a mild
restriction of forward bending, mild paraspinous muscle spasm, and
no neurologic defects.

When asked about factors that aggravated or relieved his pain, he
related that the only maneuver that attenuated the symptom was
flying upside down in his rebuilt open-cockpit biplane, suspended
by the seat belt and shoulder harness. This treatment had to be
administered in repeated brief bursts, since the aircraft operated
on a gravity-dependent fuel-injection system; after 10 seconds
upside down, the engine would stall and need to be restarted during
a dive. On the other hand, his back pain was aggravated by
prolonged flying in the usual (right-side-up) position. In fact,
the current exacerbation was attributed to a recent flying trip
with his wife, during which she would not permit him to fly upside
down.

This case raises a number of interesting questions, not least among
them being issues of risk-benefit ratios, cost effectiveness, and
even utilization review, assuming that fuel costs may be
reimbursable by the patient's third-party insurance carrier... In
any case, the time is ripe for a study comparing this approach with
the use of gravity-inversion boots.

Robert S. Hoffman, M.D.
Daly City, CA 94015 Peninsula Neurological Associates
 
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