In Assessing Back Pain, Focus on the Patient

Other back pain misconceptions are centered around pathologies identified on imaging studies, such the proverbial disk bulge or herniation.

“The prevalence of chronic back pain seems to be increasing, and it is the second most common cause of disability and lost work days in the United States,” Dr. Glick said. “Although it is not a leading cause of mortality, it is clearly a cause of suffering. We already have a variety of clinical tools at our disposal for treating patients with back pain; the key to enhancing clinical outcomes is to know which patient requires which treatment.”

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The most important tools used for differential diagnosis are the patient’s history, the clinical examination, and experience of the clinician. During a routine assessment, clinicians should make note of tendon reflexes, conduct a sensory examination, and evaluate motor function.

“Clinical guidelines and algorithms are a double-edged sword,” he said. “While they can be effective in helping to establish a minimal standard of care, clinicians do not always adhere to the guidelines. This is especially true for back pain.”

It is important for the practitioner to look for the underlying cause of a patient’s pain. Remember: pain is a symptom, not a disease. The etiology of back pain can be mechanical/musculoskeletal, inflammatory, infectious, metabolic, or neoplastic.

“Through enhanced, more precise differential diagnosis, one is increasing the likelihood of a favorable clinical outcome with appropriate treatment,” Dr. Glick said. “The idea here is that a little effort goes a long way toward decreasing or eliminating the patient’s pain, not to mention better allocation of resources.”

This article originally appeared on MPR