title: A modified Delphi survey on the signs and symptoms of low back pain: indicators for an interventional management approach.
abstract: BACKGROUND
  Low back pain (LBP) symptoms and signs are nonspecific. If required, diagnostic blocks may find the source of pain, but indicators of suspect diagnosis must be defined to identify anatomical targets.
  
  
  OBJECTIVE
  To reach a consensus from an expert panel on the indicators for the most common causes of LBP.
  
  
  METHODS
  A 3-round (2 telematic and 1 face-to-face) modified Delphi survey with a questionnaire on 78 evidence-based indicators of 7 LBP etiologies was completed by 23 experts.
  
  
  RESULTS
  98.7% of the questionnaire was consensuated. The most accepted indicators were for zygapophysial joint pain, painful ipsilateral paravertebral palpation, worsening with trunk extension, paravertebral musculature spasm on the affected articulation, and referred pain above the knee, without radicular pattern. For sacroiliac joint pain, unilateral pain when seating, with at least 3 described provoking tests: Approximation; gapping; Patrick's; Gaenslen's; thigh thrust; Fortin finger; and Gillet's tests. For discogenic pain, midline pain that may be provoked by pressure on the spinal processes at the affected level; for quadratus lumborum muscle, painful palpation on both the L1 level paravertebral region, referred to iliac crest, and the iliac crest, referred to greater trochanter. For iliopsoas muscle, pain elicited by thigh flexion, referred to buttock, inguinal region, and anterior thigh. For pyramidal muscle, pain while sitting on the affected side and positive Freiberg's test. For radicular pain, paresthesias and positive Lassègue's test at 60°.
  
  
  CONCLUSIONS
  Seventy-seven diagnostic suspect indicators of LBP conditions were consensuated. These may facilitate conservative or interventional pain management decision-making.
authors: Pain Unit, Department of Anesthesiology and Reanimation, "Virgen de la Salud" University Hospital, Toledo Hospital Complex, Toledo, Spain.
authors: José
authors: J
authors: Cid
authors: José L
authors: JL
authors: De La Calle
authors: Esther
authors: E
authors: López
authors: Cristina
authors: C
authors: Del Pozo
authors: Alfredo
authors: A
authors: Perucho
authors: María Soledad
authors: MS
authors: Acedo
authors: Dolores
authors: D
authors: Bedmar
authors: Javier
authors: J
authors: Benito
authors: Javier
authors: J
authors: De Andrés
authors: Susana
authors: S
authors: Díaz
authors: Juan Antonio
authors: JA
authors: García
authors: Leticia
authors: L
authors: Gómez-Caro
authors: Adolfo
authors: A
authors: Gracia
authors: José María
authors: JM
authors: Hernández
authors: Joaquín
authors: J
authors: Insausti
authors: María
authors: M
authors: Madariaga
authors: Pedro
authors: P
authors: Moñino
authors: Manuel
authors: M
authors: Ruiz
authors: Estrella
authors: E
authors: Uriarte
authors: Alfonso
authors: A
authors: Vidal
mesh_terms: D018771:Arthralgia / Q000150:complications / Q000175:diagnosis*; D064131:Back Muscles; D003697:Delphi Technique; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000150:complications / Q000175:diagnosis*; D017116:Low Back Pain / Q000175:diagnosis* / Q000209:etiology; D008159:Lumbar Vertebrae; D063806:Myalgia / Q000150:complications / Q000175:diagnosis*; D011843:Radiculopathy / Q000150:complications / Q000175:diagnosis*; D012446:Sacroiliac Joint; D011795:Surveys and Questionnaires; D063189:Symptom Assessment; D021801:Zygapophyseal Joint
keywords: Delphi; back pain symptoms; chronic spinal pain; consensus statement; diagnostic blocks; interventional techniques; low back pain; lumbalgia; panel experts; signs