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Lower Back Pain Frequently Originates Elsewhere
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Posted on: 01/22/2009
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The authors of this article investigated the frequency of lower back pain originating from the sacroiliac joint and the hip. By discovering this, doctors may be better able to develop alternative diagnosis and treatment, rather than just treating the back pain.
Researchers reviewed the records of patients who presented with back pain for the first time. They focused on 368 patients who were seen in one spinal surgeon's clinic. Of these patients, 289 complained of lower back pain with or without leg pain, for the first time, the remaining 200 patients had undergone surgery for the lower back pain before.
To assess the patients, the researchers reviewed the history and examination findings, and any tests that were done, such as x-rays, computed tomography imaging (CT scans), and magnetic resonance imaging (MRIs). Patients had also had injections into the spine and area to help relieve pain. Some patients also underwent a test called a discography, sometimes called a discogram. To do this test, your doctor inserts a needle into the disc and injects a dye. This fluid increases the pressure in the disc, which can cause pain. The patient then rates the pain.
The patients' hips were assessed by reports of where the pain was, such as in the groin area, when starting to walk, difficulty crossing legs, and increased pain of the hips were forced to move as the doctor checked for how much range of motion the hips had. Imaging tests may also have been done. If the patients had pain in the sacroiliac region, they were diagnosed as having SI problems and then were given injections into the joint or had physical therapy.
The findings of the study showed that 164, or 82 percent, of the patients had lower back pain, but only 130 of the patients, or 65 percent, experienced the pain directly because of the back. Thirty-five patients (17.5 percent) of the patients had pain caused by spine plus hip causes and/or because of the sacroiliac joint and the back. Sixteen patients (8 percent) had only hip or sacroiliac causes, not back. Cause of pain wasn't pinned down in 20 patients (10 percent).
Interpreting the findings, the authors wrote that up to one quarter of patients who have lower back pain could have pain caused by something other than the back and up to 10 percent may not have any identifiable cause. This makes it important that the diagnosing doctor be aware of the alternative pain causes, testing for them before assuming that the injury is entirely back-related.
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References:
Jonathan N. Sembrano, MD, and Dave. W. Polly, Jr. MD. How Often is Low Back Pain not Coming from the Back? In Spine. January 2009. Vol. 34. Pp. E27 to E32.
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