A new Australian study has revealed good news for people with a new bout of back pain. Contrary to the common fear that back pain could indicate serious diseases such as cancer, research conducted by The George Institute shows that low back pain is rarely caused by serious disease.
Researchers assessed 1200 patients to investigate how commonly low back pain is due to an undiagnosed disease or unrecognised fracture. They followed patients who presented to their GP, physiotherapist or chiropractor with a new episode of low back pain for a period of one year.
"Many people worry that their back pain may be an indicator of something more serious. Out of 1200 patients with low back pain, we found that only 11 cases of back pain were caused by a disease, but these were predominantly vertebral fractures, not serious life-threatening diseases. There were no cases of cancer and no cases of infection," according to Professor Chris Maher, The George Institute.
The World Health Organization (WHO) estimates that global prevalence of lower back pain could be as high as 42%. In Australia about 45% of people will have suffered low back pain in the previous fortnight.
Researchers also tested the accuracy of ‘red flags’ in screening for disease. Red flags are simple clinical features such as unexplained weight loss that suggest that the patient’s back pain may be due to an unrecognised disease. Clinicians consider these ‘red flags’ to help decide which patients require further diagnostic workup, such as imaging and blood tests. This approach is recommended in all national treatment guidelines for low back pain including those produced in Australia by the National Health and Medical Research Council.
"We found that many of the red flags currently being used by practitioners are not helpful indicators, as they are present in many people who are free of disease and potentially can set off a false alarm. Some red flags in particular had very high false alarm rates and need to be interpreted quite carefully, as we saw it was quite common for people to have two red flags present and not be suffering from serious disease. Our research shows that diagnostic guidelines for low back pain need urgent re-evaluation. We hope that these findings will inform international guidelines."
As vertebral fracture was the most common disease identified as the cause of back pain, the researchers were able to develop a tool to screen for undiagnosed fracture. The tool comprises four key ‘red flags’ that increase the likelihood of fracture:
- Female patient;
- Over 70 years of age;
- Sustained a significant trauma;
- Pprolonged use of corticosteroids.
(Source: The George Institute: October 2009)