Journal of General Internal Medicine

, Volume 3, Issue 3, pp 230–238 | Cite as

Cancer as a cause of back pain

Frequency, clinical presentation, and diagnostic strategies
  • Richard A. Deyo
  • Andrew K. Diehl
Original Articles


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.

Key words

cancer back pain clinical strategies x-ray utilization 


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Copyright information

© Society of General Internal Medicine 1988

Authors and Affiliations

  • Richard A. Deyo
    • 1
  • Andrew K. Diehl
  1. 1.Health Services Research and DevelopmentSeattle V.A. Medical CenterSeattle

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