In Assessing Back Pain, Focus on the Patient

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With complaints of chronic back pain increasing in frequency, clinicians are being forced to strengthen their examination and assessment skills on a regular basis
With complaints of chronic back pain increasing in frequency, clinicians are being forced to strengthen their examination and assessment skills on a regular basis

With complaints of chronic back pain increasing in frequency, clinicians are being forced to strengthen their examination and assessment skills on a regular basis. A patient-centered approach is often necessary for a practitioner to formulate an appropriate differential diagnosis.

“The idea of a patient-centered approach is based upon taking a step backward and placing greater attention on identifying that particular patient's pain generator(s) resulting in their clinical presentation of back pain,” said David M. Glick, DC, DAAPM, CPE, FASPE, managing director of Pain Rx/Neural Pain Assessment in Richmond, Virginia. “With a more precise working clinical diagnosis, it is then possible to better target treatment directly toward that presenting pathology.”

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Before using a patient-focused method, clinicians may first want to think about discarding back pain misconceptions as not doing so can lead to mishaps later on, such as when establishing a differential diagnosis.

“It is difficult to answer the question concerning why there are misconceptions about back pain,” Dr. Glick said. “Truthfully, there really does not need to be. Several are so well rooted; altering such common misconceptions about back pain seems a more difficult task than treating the underlying pain.”

While there are many misconceptions about back pain, one of the most common false beliefs is that back pain is thought of as pathology.

“Back pain is actually a symptom,” he said. “There are numerous musculoskeletal pathologies that can manifest with back pain as a symptom.  Complicating matters further, in the case of chronic back pain, is that there are often overlapping pathologies or underlying pain generators.”

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