Low Back Pain Rarely Signals Cancer

Spinal malignancy red flag predictors need to be better defined

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) If you’ve ever had low back pain, you’re a member of a large club. An estimated 70 percent of individuals have low back pain at some point in their lives. But how often does low back pain signal something more serious? Very rarely.

A recent study looked at what “red flags” could be used to indicate the need for further testing of low back pain (LBP). After combing through previous studies, the researchers concluded that more research is needed.

A combination of factors needs to be defined to help doctors know when further testing is needed. Otherwise, patients are needlessly exposed to radiation from imaging tests.

"Tell your doctor if you're experiencing low back pain."

Nicholas Henschke, PhD, of the  Institute of Public Health, University of Heidelberg in Heidelberg, Germany, led a team of researchers who conducted a systematic review of eight studies involving 6,622 patients. The objective of this review was to see how accurate red flags were for predicting spinal tumors in LBP patients.

“Red flags” are features from the patient’s clinical history and physical examination which are thought to be associated with a higher risk of serious pathology,” the authors wrote.

Previous studies looked at a combination of red flags that may warrant further testing – patient history of cancer, being over the age of 50, unexplained weight loss and pain that persisted for a month or longer.

Clinicians are advised not to begin imaging tests – such as X-rays, CT (computed tomography) or MRI (magnetic resonance) scans – until after they have performed a physical exam and reviewed the patient’s medical records.

Researchers found that, outside of having a history of cancer, few red flags were of value. Spinal malignancies were detected in less than 1 percent of study participants with LBP.

“With the exception of having a previous history of cancer, most red flag characteristics on their own were poor at predicting spinal malignancy [spinal tumors] in patients with lower back pain,” said Dr. Henschke.

“The use of these red flags as triggers for further investigations leads to unnecessary tests that can themselves be harmful,” he added.

Dr. Henschke concluded that additional large studies are needed to develop an algorithm or other tool that will help clinicians know which LBP patients should be further tested.

“In particular, we will need to see studies assessing combinations of different red flags. Our review focused on the diagnostic accuracy of individual red flags, whereas in practice it is more likely that several factors will be taken into consideration before a recommendation is made for further tests,” Dr. Henschke said.

Findings from this review were published February 27 in The Cochrane Library. No funding or financial disclosure information was provided.

Reviewed by: 
Review Date: 
February 27, 2013
Last Updated:
March 29, 2013