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Cancer as a cause of back pain

Frequency, clinical presentation, and diagnostic strategies

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Abstract

Back pain is very common. Rarely, it may be the first manifestation of cancer. Although many advocate selective use of laboratory and x-ray tests for back pain patients, the early detection of cancer may be an important reason to obtain such tests. To develop a diagnostic approach that would identify malignancies while remaining parsimonious, the authors evaluated 1,975 walk-in patients with α chief complaint of back pain. Thirteen patients (0.66%) proved to have underlying cancer. Findings significantly associated with underlying cancer (p<0.05) were: age ≥50 years, previous history of cancer, duration of pain>1 month, failure to improve with conservative therapy, elevated erythrocyte sedimentation rate (ESR), and anemia. Combining historical features and ESR results led to an algorithm that would have limited x-ray utilization to just 22% of subjects while recommending an x-ray for every cancer patient. It would further suggest which patients with negative x-ray findings require further work-up.

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References

  1. Cypress BK. Characteristics of physician visits for back symptoms: a national perspective. Am J Public Health 1983;73:389–95

    PubMed  CAS  Google Scholar 

  2. Koch H, Gagnon RO. Office visits involving x-rays, National Ambulatory Medical Care Survey: United States, 1977. Advance data from vital and health statistics. No. 53, DHEW Publication No. (PHS) 79–1250, 1979, pp 1–7

  3. Hall FM. Back pain and the radiologist. Radiology 1980;137:861–3

    PubMed  CAS  Google Scholar 

  4. Liang M, Komaroff AL. Roentgenograms in primary care patients with acute low back pain: a cost-effectiveness analysis. Arch Intern Med 1982;142:1108–12

    Article  PubMed  CAS  Google Scholar 

  5. Gilbert TCW, Kim J, Posner JB. Epidural spinal cord compression from metastatic tumor: diagnosis and treatment. Ann Neurol 1978;3:40–51

    Article  PubMed  CAS  Google Scholar 

  6. Deyo RA. The early diagnostic evaluation of low back pain. J Gen Intern Med 1986;1:328–38

    Article  PubMed  CAS  Google Scholar 

  7. Nachemson AL. The lumbar spine: an orthopedic challenge. Spine 1976;1:59–71

    Article  Google Scholar 

  8. Fries JF, Mitchell DM. Joint pain or arthritis. JAMA 1976;235:199–204

    Article  PubMed  CAS  Google Scholar 

  9. Rockey PH, Tompkins RK, Wood RW, Wolcott BW. The usefulness of x-ray examinations in the evaluation of patients with back pain. J Fam Pract 1978;7:455–65

    PubMed  CAS  Google Scholar 

  10. MacNab I. Backache. Baltimore: Williams and Willkins, 1997;131–2

  11. Schutte HE, Park WM. The diagnostic value of bone scintigraphy in patients with low back pain. Skeletal Radiol 1983;10:1–4

    Article  PubMed  CAS  Google Scholar 

  12. Fernbach JC, Langer F, Gross AE. The significance of low back pain in older adults. Can Med Assoc J 1976;115:898–900

    PubMed  CAS  Google Scholar 

  13. Deyo RA, Diehl AK. Lumbar spine films in primary care: current use and effects of selective ordering criteria. J Gen Intern Med 1986;1:20–5

    Article  PubMed  CAS  Google Scholar 

  14. Greenfield S, Anderson H, Winickoff RN, et al. Nurse-protocol management of low back pain. West J Med 1975;123:350–9

    PubMed  CAS  Google Scholar 

  15. Sackett DL, Haynes RB, Tugwell P. Clinical epidemiology: a basic science for clinical medicine. Boston, Little, Brown, 1985;59–138

  16. Hanley JA, Lippman-Hand A. If nothing goes wrong, is everything all right? Interpreting zero numerators. JAMA 1983;249:1743–5

    Article  PubMed  CAS  Google Scholar 

  17. Bulpitt CJ. Confidence intervals. Lancet 1987;i:494–7

    Article  Google Scholar 

  18. Miller A, Green M, Robinson D. Simple rule for calculating normal erythrocyte sedimentation rate. Br Med J 1983;286:266

    Article  CAS  Google Scholar 

  19. Dillane JB, Fry J, Kalton G. Acute back syndrome—a study from general practice. Br Med J 1966;2:82–4

    Google Scholar 

  20. Schaberg J, Gainor BJ. A profile of metastatic carcinoma of the spine. Spine 1985;10:19–20

    Article  PubMed  CAS  Google Scholar 

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Received from the Division of General Internal Medicine, Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, and the Seattle Veterans Administration Medical Center, Seattle, Washington.

Supported in part by a grant from the Robert Wood Johnson Foundation, Princeton, New Jersey, and by the Northwest Health Services Research and Development Field Program, Seattle V.A. Medical Center.

The opinions, conclusions and proposals in the text are those of the authors, and do not necessarily represent the views of the Robert Wood Johnson Foundation.

Margaret Moya, Helen Provot, and Nancy Sugarek provided expert technical assistance. Richard L. Bauer, MD, and Daniel Kent, MD, provided helpful reviews of an earlier version of the manuscript. Ms. Moya and Kathy Minotto assisted in preparing the manuscript. The cooperation of the housestaff of the Medical Center Hospital who completed clinical evaluations of the patients is greatly appreciated.

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Deyo, R.A., Diehl, A.K. Cancer as a cause of back pain. J Gen Intern Med 3, 230–238 (1988). https://doi.org/10.1007/BF02596337

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