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Dear Charlie, The surgical study you presented supports my thinking- not all chronic back patients have psychological issues- some get better from surgery & other treatments! I believe that Di stated that chronic patients fall into 2 groups- both with some sort of psychological issues- she left no room for this 3rd group who recover eventually once their mechanical problems are corrected or compensated for. I agree, however, especially depending on your setting, that many, possibly most chronic patients no matter what the patho or joint involved have some psychological component in addition to physical. As far as not knowing much diagnostically, in the past few years, a research article reported that 80% of back patients do not have a specific diagnosis. I don't consider this a high point for the medical community. (I'd be happy to look up the reference.) Finally, someone on this list stated that they ask patients questions if the rehab is not going well. Great idea, but be careful of what you're asking. Patients are not idiots- they know what you're getting at, and may feel offended if you go to far (they do not consider us to be psychological professionals- so I wouldn't do any diagnosing!!). Jill K %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%