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Diagnostic Evaluation of LBP
Reaching a Specific Diagnosis Is Often Impossible
Richard A. Deyo, MD, MPH
Arch Intern Med. 2002;162:1444-1447.
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INTRODUCTION
THE DISEASE management paradigm that has served medicine so well involves making a specific diagnosis of anatomic or physiologic derangements and selecting specific therapies that address them. Thus, we have moved away from empirically treating symptoms to modifying pathophysiologic conditions. Unfortunately, this paradigm often fails us in the patient with LBP because the precise cause remains unclear in most cases. Anatomic abnormalities can be readily identified by imaging studies, but most of these abnormalities are common even in healthy people. Thus, finding a cause for LBP is often difficult or impossible.
Furthermore, as we learn more about the evolution of chronic pain syndromes, evidence suggests that mood disorders, perceptual styles, and cognitive, social, and even financial factors may help determine who develops back pain and who becomes disabled by it. Many patients with chronic pain syndromes may have central neuroplastic changes (neuronal hyperactivity, changes in . . . [Full Text of this Article]
ANATOMIC ABNORMALITIES IN HEALTHY PEOPLE
NONSPECIFIC TREATMENTS
IDENTIFYING SPECIFIC PATHOLOGIC CONDITIONS
LABELING EFFECTS
EMPIRICAL COMPARISONS OF IMAGING STRATEGIES
A PROPOSED CLINICAL STRATEGY
From the Departments of Medicine and Health Services and the Center for Cost and Outcomes Research, University of Washington, Seattle.
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ABSTRACT
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