Mixing and matching can work for back pain

This issue details management of back pain, a forum on monkeypox, and pearls about diagnosing delirium.

Back pain is one of the most common reasons for patients to present to their physicians, and it can be one of the most frustrating conditions to treat. While patients, understandably, are looking for relief, there are often no quick fixes and little definitive evidence to guide therapy. But physicians can find success by listening to patients' preferences, communicating expectations, and combining different modalities, according to experts. Our story in this issue reviews ACP's 2017 guideline on noninvasive approaches to acute, subacute, and chronic low back pain and offers suggestions on determining an individualized treatment strategy for each patient.

Following close on the heels of COVID-19, the human monkeypox virus has infected more than 27,500 people in the U.S. and was declared a public health emergency in August. Physicians already exhausted from dealing with the pandemic are now facing a new infectious foe. To help answer some of their most pressing questions, ACP and Annals of Internal Medicine held a virtual online forum on Oct. 11 featuring clinical vignettes and advice from a panel of infectious disease experts. Read our story for five key takeaways from the forum for physicians, as well as news about a federally funded trial of tecovirimat that is currently enrolling patients.

This issue's Pearls from I.M. Peers features Katie Drago, MD, FACP, assistant professor of medicine in the division of general internal medicine and geriatrics at Oregon Health & Science University in Portland, and reviews her tips on assessing delirium. Learn why simply knocking on a patient's door can give you vital information and hear more of Dr. Drago's advice.

Sue Bornstein, MD, MACP, Chair of ACP's Board of Regents, guest-wrote the President's Message column in this issue. She details the silent epidemic of intimate partner violence, issues a call to action for physicians, and describes new educational modules on the topic recently launched by ACP. Also, Shari Erickson, ACP's Chief Advocacy Officer and Senior Vice President of Governmental Affairs and Public Policy, describes the urgent need for continued advocacy on firearms violence, explaining why statements of sorrow and support are not enough.

Elsewhere in this issue, our Practice Rx column provides an overview of the Medicare Advantage program, and another story offers the latest information on ACP's upcoming elections.

Have you seen any cases of monkeypox? How do you manage low back pain in your patients? Let us know at


Jennifer Kearney-Strouse
Executive Editor