title: Shadows of the truth in patients with spinal pain: a review.
abstract: OBJECTIVE
  Spinal pain with or without referred pain is a major and costly health problem that can arise from many anatomical structures. Sophisticated diagnostic imaging devices cannot show some of these structures, and frequently imaging provides only a shadow of the truth. This review illustrates how symptoms may well have an organic cause that is not detectable by current methods of examination, including imaging.
  
  
  METHODS
  This study reviews some histopathological findings that can be associated with spinal pain with or without referred pain but cannot be seen on imaging.
  
  
  RESULTS
  Some histopathological changes illustrate imaging device limitations.
  
  
  CONCLUSIONS
  Awareness of the considerable limitations of even sophisticated imaging devices is necessary when managing patients with acute or chronic spinal pain with or without referred pain. Symptoms may well be genuine and not of psychogenic origin: a diagnosis of malingering, therefore, should not be made lightly.
authors.affiliation: National Centre for Multidisciplinary Studies of Back Pain, Townsville General Hospital, Queensland, Australia.
authors.forename: L G
authors.initials: LG
authors.lastname: Giles
authors.forename: C M
authors.initials: CM
authors.lastname: Crawford
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000209:etiology* / Q000473:pathology; D008159:Lumbar Vertebrae / Q000473:pathology; D008297:Male; D008306:Malingering / Q000175:diagnosis; D012447:Sacrum / Q000473:pathology; D013001:Somatoform Disorders / Q000175:diagnosis; D013122:Spinal Diseases / Q000175:diagnosis* / Q000473:pathology