Diagnosing Back Pain

Diagnosing Back Pain for GPs:

At any one time, back pain affects one in four Australians and is a common cause of GP visits. To help you diagnose your patient’s discomfort, here are the four major categories of back pain.

1. Back pain and cancer

The most important diagnostic indicator is the patient’s history. Has there been any previous instance of cancer?

Two other factors to bear in mind are:

• whether the back pain is new and deteriorating without any let-up in pain symptoms
• if there are neurological symptoms.

If any of these are present, it is recommended that you get an MRI scan for the patient and make a referral to a specialist. Time is of the essence.

2. Nerve pain emanating from the back when it is serious.

If the patient has sciatica, then conduct a full assessment. For patients with a significant deficit – power grade of 3/5 or worse – or a progressive loss of function, then request an MRI scan and refer your patient to a specialist.

To rule out Cauda Equina, the defining factors are back pain + sciatica + retention of urine. If the urinary function is normal then it is not cauda equina.

3. Deformities – when it is serious

These are rarely debilitating and in most cases your patient can live with them quite happily.

The only exceptions to this are:

• there is an obvious lateral imbalance to one side or the other, or your patient is leaning forwards
• the condition deteriorates progressively over time
• there is an association with nerve pain.

In which case, please make a referral.

Note: please ignore any attempt by radiologists to estimate the size of the incline in scoliosis. They are invariably inaccurate.

4. Non-specific back pain – when should it be taken seriously?

Most back pain will resolve itself and patients just need reassurance. Some pain is part of life.

Some patients however do poorly. Their psycho-social make means that they can tend to catastrophise. They need either counselling or pain management. If not addressed in a professional way, they will end up with chronic back pain.

Keele University in the UK has developed an effective diagnostic tool: STarT Back Screening Test. It helps identify patients at risk of catastrophising.

You can watch the recording of my webinar on Diagnosing back pain here.

And as always if you have any questions about a patient, please feel free to call me on 02 9650 4893. I will return your call and discuss how we can help.

You can also reach me via ralphstanford@powspine.com.au.

Further Resources for Referrers include:

• Webinar: Cauda Equina Syndrome
• Tumours of the spine
• Sinister Causes of Back Pain
• Webinar: Sinister Causes of Back Pain
• Back Pain and how to manage it
• Adult Spinal Deformities: Symptoms and Treatments

Dr Ralph Stanford is a spinal surgeon with over 20 years’ experience. He is adept in all surgical approaches to successfully treat his patients.

As a teacher Dr Ralph Stanford is Conjoint Senior Lecturer at the UNSW; Supervisor of Training for Orthopaedic Trainees, Prince of Wales Hospital; and Education Secretary for the Spine Society of Australia.

As a researcher and scientist, he is a well-published author and Honorary Senior Scientist at Neuroscience Research Australia (NeuRA). He is also a current member of Spinal PFET. 

Posted 14 November 2022