Back pain diagnostic study of choice: Difference between revisions

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__NOTOC__
__NOTOC__
{{Back pain}}
{{Back pain}}
{{CMG}}; {{AE}} {{Fs}}
{{CMG}}; {{AE}} {{ZMalik}}
== Overview ==
== 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]]).


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==
 
*There is no single [[diagnostic]] study of choice for the [[diagnosis]] of [[back]] [[pain]].
=== Study of choice ===
*[[Back]] [[pain]] is a [[symptom]] of an underlying condition, emphasis should be made in identifying the [[etiology]].
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
*The [[diagnostic]] plan should include:<ref name="pmid23419406">{{cite journal| author=Wang H, Cheng J, Xiao H, Li C, Zhou Y| title=Adolescent lumbar disc herniation: experience from a large minimally invasive treatment centre for lumbar degenerative disease in Chongqing, China. | journal=Clin Neurol Neurosurg | year= 2013 | volume= 115 | issue= 8 | pages= 1415-9 | pmid=23419406 | doi=10.1016/j.clineuro.2013.01.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23419406  }} </ref><ref name="pmid7562959">{{cite journal| author=Gran JT, Husby G| title=HLA-B27 and spondyloarthropathy: value for early diagnosis? | journal=J Med Genet | year= 1995 | volume= 32 | issue= 7 | pages= 497-501 | pmid=7562959 | doi=10.1136/jmg.32.7.497 | pmc=1050539 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7562959  }} </ref>
 
**Detailed history
OR
**[[Physical examination]]
 
**Identification of red flags<ref name="pmid31899561">{{cite journal| author=Welk B, Baverstock R| title=Is there a link between back pain and urinary symptoms? | journal=Neurourol Urodyn | year= 2020 | volume= 39 | issue= 2 | pages= 523-532 | pmid=31899561 | doi=10.1002/nau.24269 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31899561  }} </ref><ref name="pmid25790449">{{cite journal| author=Lumley MA, Schubiner H, Carty JN, Ziadni MS| title=Beyond traumatic events and chronic low back pain: assessment and treatment implications of avoided emotional experiences. | journal=Pain | year= 2015 | volume= 156 | issue= 4 | pages= 565-566 | pmid=25790449 | doi=10.1097/j.pain.0000000000000098 | pmc=4369787 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25790449  }} </ref><ref name="pmid8434327">{{cite journal| author=Polatin PB, Kinney RK, Gatchel RJ, Lillo E, Mayer TG| title=Psychiatric illness and chronic low-back pain. The mind and the spine--which goes first? | journal=Spine (Phila Pa 1976) | year= 1993 | volume= 18 | issue= 1 | pages= 66-71 | pmid=8434327 | doi=10.1097/00007632-199301000-00011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8434327  }} </ref><ref name="pmid25125938">{{cite journal| author=Mabry LM, Ross MD, Tonarelli JM| title=Metastatic cancer mimicking mechanical low back pain: a case report. | journal=J Man Manip Ther | year= 2014 | volume= 22 | issue= 3 | pages= 162-9 | pmid=25125938 | doi=10.1179/2042618613Y.0000000056 | pmc=4101555 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25125938  }} </ref>
The following result of [gold standard test] is confirmatory of [disease name]:
***[[Intestine|Bowel]] [[incontinence]]  
* [Result 1]
***[[Urinary bladder|Bladder]] [[incontinence]]  
* [Result 2]
***Progressive [[weakness]] in [[legs]]
 
***[[Sleep]] interrupted due to severe [[back]] [[pain]]
OR
***[[Fever]]
 
***[[Depression]]
[Name of the investigation] must be performed when:
***Unexplained [[weight loss]]
* The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
***[[Back]] [[pain]] due to [[trauma]]
* A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.
***Increased [[back]] [[pain]] in [[patients]] with [[osteoporosis]] or [[multiple myeloma]]
 
***Repetitive intense [[exercise]] involving lumbar [[extension]]
OR
***Long term [[corticosteroid]] use (can cause [[fractures]])
 
**[[Imaging]], if indicated (preferably an [[MRI]])
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
**Laboratory evaluation ([[CBC]], [[ESR]], [[CRP]], [[ANA]], [[RF]], [[LDH]], [[uric acid]], [[HLA-B27]])
 
OR
 
The diagnostic study of choice for [disease name] is [name of the investigation].
 
OR
 
There is no single diagnostic study of choice for the diagnosis of [disease name].
 
OR
 
There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
 
OR
 
[Disease name] is primarily diagnosed based on the clinical presentation.
 
OR
 
Investigations:
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
 
==== The comparison of various diagnostic studies for [disease name] ====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|}
<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>
 
===== Diagnostic results =====
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
* [Finding 1]
* [Finding 2]
 
===== Sequence of Diagnostic Studies =====
The [name of investigation] must be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
 
OR
 
The various investigations must be performed in the following order:
* [Initial investigation]
* [2nd investigation]
 
=== Name of Diagnostic Criteria ===
 
'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''
 
[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
 
OR
 
There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
 
OR
 
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
[Disease name] may be diagnosed at any time if one or more of the following criteria are met:
* Criteria 1
* Criteria 2
* Criteria 3
 
OR
 
'''IF there are clear, established diagnostic criteria'''
 
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
'''IF there are no established diagnostic criteria'''
 
There are no established criteria for the diagnosis of [disease name].


==References==
==References==

Latest revision as of 21:49, 29 May 2021

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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).

Diagnostic Study of Choice

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.

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