The evaluation of CLBP patients is often a search for the needle in a haystack with regard to the presence of serious underlying pathology or surgically correctable disease.24' 25 There is a tendency, then, to be somewhat dismissive with regard to the evaluation of these patients in a busy practice. However, one must remain vigilant as to not miss the patient with real pathology (Box 37.2).26
The chronic low back pain patient, who has presented on numerous occasions, can subsequently develop a life-threatening reason for their pain. They may only complain of worsening symptoms over time or an additional area of pain, when indeed they are harboring a new cancer, infection, or fracture. The patient with psychological overlay or the possibility of chronic pain syndrome similarly can have a serious underlying reason for their pain.
The poor historian presents a unique challenge as many of the spine disease subcategories are defined best by their historical features. The challenge for the clinician is to dig deeper and spend the extra time to ensure that nothing is missed. Then there are those patients whose records indicate visits to many of your colleagues or other clinicians in the region and are now in your office with the same complaints. Clinicians can fall into the trap of assuming that a proper evaluation must have been completed by someone along the way. It is important to follow through on a meticulous and systematic evaluation, independent of previous diagnoses given in the past.
Was this article helpful?
Tired Having Back Pains All The Time, But You Choose To Ignore It? Every year millions of people see their lives and favorite activities limited by back pain. They forego activities they once loved because of it and in some cases may not even be able to perform their job as well as they once could due to back pain.