doi:10.1016/j.jemermed.2009.07.037 Clinical Communications: Adults A MORTAL FOLK REMEDY: ROPE WRAPPING TO THE BACK Zeynep Cakir, MD,* Murteza Cakir, MD,† Sahin Aslan, MD,* Mucahit Emet, MD,* and Ayhan Saritas, MD* *Department of Emergency Medicine, Ataturk University, School of Medicine, Erzurum, Turkey and †Department of Neurosurgery, Erzurum Education and Research Hospital, Erzurum, Turkey Reprint Address: Sahin Aslan, MD, Department of Emergency Medicine, Atatürk University, School of Medicine, Erzurum 25090, Turkey e Abstract—Background: Despite the developments in medicine in recent years, people in many regions of the world still tend to use alternative, or non-medical, folkloric treatment methods for many different health problems. One of these methods is “rope wrapping to the back,” which is considered to be therapeutic for patients with lumbar disc hernias or low back pain. This method is practiced by local individuals without medical training. Case Report: Over the course of 3 years, 14 patients, 8 women and 6 men, presented to Atatürk University and Erzurum state hospi- tals in eastern Turkey after undergoing the folk treatment known as “rope wrapping to the back” for low back pain. One of the patients, who had symptoms of systemic infec- tion, later died. Of the other patients, 4 had local infections, 6 had unresolved complaints, and 3 had other complaints. Nine of the patients were treated in the emergency depart- ment and 4 required surgery. Two case reports are pro- vided as examples. Conclusion: Improvements are needed to increase the accessibility of health care, improve phy- sician–patient communication, and provide information to people, so as to prevent the use of folk remedies, which can have serious complications, sometimes resulting in death. © 2009 Elsevier Inc. e Keywords—low back pain; lumbar herniation; folk remedy INTRODUCTION Lumbar disc herniation is a significant disease that is accompanied by symptoms of low back pain, leg pain, and lack of strength. Due to these symptoms, it often results in lost work days and reduction in the workforce, potentially creating socioeconomic problems. This dis- ease may be treated by conservative or surgical methods (1). In eastern Turkey, sociocultural and economic fac- tors, as well as a lack of knowledge about disc hernia surgery, may lead people to seek out unconventional methods (2). The majority of these methods do not provide any benefit for patients, but instead interfere with definitive treatment, and may even result in notable dis- orders, disabilities, or even death (3,4). In this report we provide two cases as examples, and then report on a series of 14 patients presenting to Atatürk University and Erzurum state hospitals in the eastern region of Turkey. CASE REPORT Case 1 A 48-year-old man presented to the Emergency Depart- ment (ED) with complaints of impaired general status, fever, and a wound in the lumbar region that was swol- len, painful, and had a discharge. From the patient’s anamnesis, it was learned that 15 days earlier a woman in a neighboring village had attempted to treat the patient’s back pain and leg paresthesia by using “rope wrapping” to his back. Ten days after he had undergone the appli- cation, a purulent discharge appeared from wounds RECEIVED: 24 March 2009; FINAL SUBMISSION RECEIVED: 20 May 2009; ACCEPTED: 23 July 2009 The Journal of Emergency Medicine, Vol. xx, No. x, pp. xxx, 2009 Copyright © 2009 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/09 $–see front matter 1 ARTICLE IN PRESS