I would like to present another pole of the managed care issue using this case. It is clear from this case report, although not presented as such, that this patient had chronic neck pain and was a chronic pain patient. Multidisciplinary pain facilities have been shown in a number of meta-analyses to be effective in treatment for a number of outcome variables, such as less pain, greater function, and return to work (1–3). These meta-analyses have even been critically reviewed and found to be of good quality (4). It is interesting that referral to a multidisciplinary pain facility, however, was not considered, in spite of the fact that nonintegrated treatment of this patient had previously failed. The kind of treatments (physical therapy, counseling, psychiatry, rehabilitation, etc.) provided to this patient are usually available to patients at multidisciplinary facilities in an integrated fashion. One could then argue that a referral should have been considered.