title: Low back pain misdiagnosis or missed diagnosis: Core principles.
abstract: Consensus guidelines for the management of low back pain recommend that the clinician use contemporary best practice for assessment and treatment, consider biopsychosocial factors and, if chronic, use a multimodal and multi-disciplinary approach. Where guidelines are not followed and basic assessment is inadequate the diagnosis may be compromised and the sequelae of errors compounded. Factors such as a lack of knowledge or recognition of the common structure specific pain referral patterns, poor clinical reasoning, inappropriate referral and predilection for popular management approaches also contribute to mis-diagnosis and mis-management. This report describes two cases of chronic low back pain with lengthy histories of multiple failed interventions to highlight the consequences of focussing on a singular approach to the exclusion of evidence based pathways and the resulting risk of a missed diagnosis. The eventual management to mitigate these problems is reported with the aid of low back pain outcome measures, computer-aided combined movement examination, disability and pain questionnaires and health quality of life surveys.
authors.affiliation: Centre for Musculoskeletal Studies, School of Surgery, The University of Western Australia, Perth, Western Australia 6009, Australia. Electronic address: aubrey.monie@research.uwa.edu.au.
authors.forename: A P
authors.initials: AP
authors.lastname: Monie
authors.affiliation: Centre for Musculoskeletal Studies, School of Surgery, The University of Western Australia, Perth, Western Australia 6009, Australia.
authors.forename: P J
authors.initials: PJ
authors.lastname: Fazey
authors.affiliation: Centre for Musculoskeletal Studies, School of Surgery, The University of Western Australia, Perth, Western Australia 6009, Australia.
authors.forename: K P
authors.initials: KP
authors.lastname: Singer
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D003951:Diagnostic Errors / Q000517:prevention & control; D003955:Diagnostic Tests, Routine / Q000592:standards*; D003975:Diazepam / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D013131:Spine / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D003975:Diazepam
keywords: Assessment; Guidelines; Low back pain; Lumbar spine