Back pain diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S [2]

Overview

There is no single diagnostic study of choice for the diagnosis of back pain. Back pain is a symptom of an underlying condition, emphasis should be made in identifying the etiology. The diagnostic plan should include, a detailed history, physical examination, identification of red flags, imaging (preferably an MRI) and laboratory evaluation (CBC, ESR, CRP, ANA, RF, LDH, uric acid, HLA-B27).

There is no single diagnostic study of choice for the diagnosis of back pain.
Back pain is a symptom of an underlying condition, emphasis should be made in identifying the etiology.
The diagnostic plan should include:^[1]^[2]
- Detailed history
- Physical examination
- Identification of red flags^[3]^[4]^[5]^[6]
  - Bowel incontinence
  - Bladder incontinence
  - Progressive weakness in legs
  - Sleep interrupted due to severe back pain
  - Fever
  - Depression
  - Unexplained weight loss
  - Back pain due to trauma
  - Increased back pain in patients with osteoporosis or multiple myeloma
  - Repetitive intense exercise involving lumbar extension
  - Long term corticosteroid use (can cause fractures)
- Imaging, if indicated (preferably an MRI)
- Laboratory evaluation (CBC, ESR, CRP, ANA, RF, LDH, uric acid, HLA-B27)

↑ Wang H, Cheng J, Xiao H, Li C, Zhou Y (2013). "Adolescent lumbar disc herniation: experience from a large minimally invasive treatment centre for lumbar degenerative disease in Chongqing, China". Clin Neurol Neurosurg. 115 (8): 1415–9. doi:10.1016/j.clineuro.2013.01.019. PMID 23419406.
↑ Gran JT, Husby G (1995). "HLA-B27 and spondyloarthropathy: value for early diagnosis?". J Med Genet. 32 (7): 497–501. doi:10.1136/jmg.32.7.497. PMC 1050539. PMID 7562959.
↑ Welk B, Baverstock R (2020). "Is there a link between back pain and urinary symptoms?". Neurourol Urodyn. 39 (2): 523–532. doi:10.1002/nau.24269. PMID 31899561.
↑ Lumley MA, Schubiner H, Carty JN, Ziadni MS (2015). "Beyond traumatic events and chronic low back pain: assessment and treatment implications of avoided emotional experiences". Pain. 156 (4): 565–566. doi:10.1097/j.pain.0000000000000098. PMC 4369787. PMID 25790449.
↑ Polatin PB, Kinney RK, Gatchel RJ, Lillo E, Mayer TG (1993). "Psychiatric illness and chronic low-back pain. The mind and the spine--which goes first?". Spine (Phila Pa 1976). 18 (1): 66–71. doi:10.1097/00007632-199301000-00011. PMID 8434327.
↑ Mabry LM, Ross MD, Tonarelli JM (2014). "Metastatic cancer mimicking mechanical low back pain: a case report". J Man Manip Ther. 22 (3): 162–9. doi:10.1179/2042618613Y.0000000056. PMC 4101555. PMID 25125938.