title: Cancer as a cause of back pain: frequency, clinical presentation, and diagnostic strategies.
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 a chief complaint of back pain. Thirteen patients (0.66%) proved to have underlying cancer. Findings significantly associated with underlying cancer (p less than 0.05)  were: age greater than or equal to 50 years, previous history of cancer, duration of pain greater than 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.
authors.affiliation: Department of Medicine, The University of Texas Health Science Center, San Antonio.
authors.forename: R A
authors.initials: RA
authors.lastname: Deyo
authors.forename: A K
authors.initials: AK
authors.lastname: Diehl
mesh_terms: D000328:Adult; D000465:Algorithms; D001416:Back Pain / Q000209:etiology*; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000175:diagnosis; D010044:Outpatient Clinics, Hospital; D011336:Probability; D013223:Statistics as Topic