Before any treatment is undertaken for the relief of these painful conditions, attempts should be made to determine the causative factors. Among the causes of parietal neuralgia, Bates⁴ has found trauma, toxic foci (particularly in the nose and throat), postural defects, any combination of these three factors, endocrine imbalance, spinal arthritis, and metastatic malignant conditions of the spine. As in any curative problem, the first consideration is elimination of the cause. From their experience with over a thousand cases of backache in neuralgia clinics, Judovich and Bates state⁵ that a predisposing factor such as lordosis, scoliosis, trauma or spinal arthritis exists in a majority of instances. It had been their experience that as little as three-eights of an inch difference in the length of the extremities is sufficient to produce a chronic tilt of the lumbar spine and a compensatory scoliosis. Frequently, corrective procedures are essential to satisfactory clinical response.

The same authors classify the etiologic factors concerned in low back pain according to the following scheme:

Group I -- Common Infections Mostly upper respiratory (Pain one or two weeks later) Focal Trauma Direct Indirect Postural Defects Scoliosis Lordosis Spinal Arthritis

Group II -- Less Common Malignancy Syphilis Diabetes Herpes Zoster Pott's Disease Spinal Cord Tumor Chemicals Blood Dyscrasias Local Lesions Dermatitis Abscess Cellulitis Myositis, etc.

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