Fowler is to visit a specialist next week amid concerns that a problem which has plagued him since the end of last season could keep him out for several months. The 30-year-old received an injection before the start of this campaign to allow him to return to training and appeared to have overcome the injury when he made his first appearance of the season as a late substitute in the Manchester derby on 10 September.
However, the £6m striker suffered a reaction to that outing and to several reserve-team appearances and City have been left with no option but to explore alternative treatments. With Fowler now in the final year of his contract at City, and Pearce keen to ensure that a fine start to the season is not derailed by an increasingly depleted attack - both Andy Cole and Bradley Wright-Phillips are also out - his absence is a worrying development for the club and for a player who has made only 74 starts since arriving from Leeds United in January 2003.
Fowler is yet to discover exactly how long he will be on the sidelines, but as the nature of the injury prevents him from doing any physical exercise, it could be several months before he returns to full fitness.
Pearce said: "He was halfway there but, after the reserve-team games, he was feeling stiff in the mornings and it is prudent to pull him out and get it treated properly rather than ask him to carry on. It doesn't help Robbie or the club for him to try and play when he is not fully fit.
"The trouble with this injury is that it will be very difficult for him to keep his fitness. Everything goes through your back so he cannot even do his work away from the training ground, such as in the pool. He is fine in himself, but disappointed that it is still not right. We don't know how long he will be out for until we receive a professional opinion on the severity of the injury."
Pearce is still coming to terms with the Carling Cup exit at Belle Vue, a defeat notable not only for the harsh dismissal of Nedum Onuoha and a controversial penalty award against Sylvain Distin by referee Graham Salisbury but also the City players' restrained reaction to both decisions.
The City manager, still awaiting confirmation that Onuoha's red card will be rescinded, has instructed his charges not to remonstrate with officials - a lesson he heeded from his former mentor at Nottingham Forest, Brian Clough.
Pearce explained: "I prefer my players not to shout and holler at referees but I wouldn't discourage them from having a quiet word and saying, 'I thought you got that decision wrong' because I think that is healthy.
"I said to the referee that I thought he had made a howler on the sending-off and he promised to have a look at it. I think that approach is the right, ethical thing to do and I just don't see how shouting helps. Cloughie had a strict code of conduct at Forest, there was to be no back-chat with referees and we never had a problem with them."Reuse content