, Volume 3, Issue 3, pp 230-238

Cancer as a cause of back pain


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 α chief complaint of back pain. Thirteen patients (0.66%) proved to have underlying cancer. Findings significantly associated with underlying cancer (p<0.05) were: age ≥50 years, previous history of cancer, duration of pain>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.

Received from the Division of General Internal Medicine, Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, and the Seattle Veterans Administration Medical Center, Seattle, Washington.
Supported in part by a grant from the Robert Wood Johnson Foundation, Princeton, New Jersey, and by the Northwest Health Services Research and Development Field Program, Seattle V.A. Medical Center.
The opinions, conclusions and proposals in the text are those of the authors, and do not necessarily represent the views of the Robert Wood Johnson Foundation.
Presented in part at the tenth annual meeting of the Society for Research and Education in Primary Care Internal Medicine, San Diego, April 30, 1987.
Margaret Moya, Helen Provot, and Nancy Sugarek provided expert technical assistance. Richard L. Bauer, MD, and Daniel Kent, MD, provided helpful reviews of an earlier version of the manuscript. Ms. Moya and Kathy Minotto assisted in preparing the manuscript. The cooperation of the housestaff of the Medical Center Hospital who completed clinical evaluations of the patients is greatly appreciated.