ESSENTIALS OF DIAGNOSIS
Neck and back pain are the most common physical conditions for which patients seek medical attention.
History and physical examination are paramount in diagnosis, as imaging is often falsely positive or negative.
Finding the root cause of the symptoms is essential.
The chief complaint of spinal pain dominates in primary care offices and emergency departments across the United States. Once thought of as nuisance conditions associated with a speedy recovery, back and neck pain are now known to produce lingering problems for many patents, with few returning to preinjury activity. Despite increasing awareness of this problem, the incidence of spinal pain remains at about 80%, with 60% of adults reporting neck or low back pain within the previous 3 months.
Pain is merely a symptom; therefore, clinicians must evaluate for anatomic and physiologic causes of the pain, many of which are discussed elsewhere in this chapter. Assessing for so-called “red flags” is essential (Table 31–1). These well-known and established indicators may require careful assessment, changes in treatment plan, or emergency care or referral to another health care specialist. Ignoring these “red flag” indicators increases the likelihood of patient harm. “Yellow flags” are psychosocial factors that have been shown to be indicative of long-term disability and can become a barrier to treatment (Table 31–2).
Table 31–1“Red flags” in back pain.
Table 31–2“Yellow flags” in back pain. |Favorite Table|Download (.pdf) Table 31–2 “Yellow flags” in back pain.
Negative attitude (ie, that back pain is harmful or potentially severely disabling)
Fear or avoidance behavior and reduction in activity levels
Expectation that passive, rather than active, treatment will be beneficial
Tendency to depression, low morale, and social withdrawal
Social or financial problems
The treatment of back and neck pain is dependent on etiology. The physiatrist must have a thorough knowledge of spinal disease in order to provide the best treatment for these patients. Although most acute exacerbations can be treated conservatively, a steady and steep rise in ...