Cancer as a cause of back pain - Frequency, clinical presentation, and diagnostic strategies

Richard A. Deyo, Andrew K. Diehl

Research output: Contribution to journalArticlepeer-review

180 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)230-238
Number of pages9
JournalJournal of General Internal Medicine
Issue number3
StatePublished - May 1 1988


  • back pain
  • cancer
  • clinical strategies
  • x-ray utilization

ASJC Scopus subject areas

  • Internal Medicine


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