In most cases, the pain subsides naturally after several weeks. People who seek diagnosis through imaging are typically less likely to receive a better outcome than are those who wait for the condition to resolve. Imaging
Magnetic resonance imaging (MRI) is the preferred modality for the evaluation of back pain and visualization of bone, soft tissue, nerves and ligaments. X-rays are a less costly initial option offered to patients with a low clinical suspicion of infection or malignancy, and they are combined with laboratory studies for interpretation. Imaging is not needed for the majority of patients with back pain. In cases of acute back pain, MRI is recommended for those with major risk factors or clinical suspicion of cancer, spinal infection or severe progressive neurological deficits. For patients with subacute to chronic back pain, MRI is recommended if minor risk factors exist for cancer, ankylosing spondylitis or vertebral compression fracture, or if significant trauma or symptomatic spinal stenosis is present.Early imaging studies during the acute phase do not improve care or prognosis. Imaging findings are not correlated with severity or outcome. Laboratory studies
Laboratory studies are employed when there are suspicions of autoimmune causes, infection or malignancy. Laboratory testing may include white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Elevated ESR could indicate infection, malignancy, chronic disease, inflammation, trauma or tissue ischemia. Elevated CRP levels are associated with infection. Red flags
Imaging is not typically needed in the initial diagnosis or treatment of back pain.
Spinal epidural abscess is commonly caused by severe infection with bacteremia. Risk factors include recent administration of epidurals, IV drug use or recent infection. Cancer
Spread of cancer to the bone or spinal cord can lead to back pain. Bone is one of the most common sites of metastatic lesions. Patients typically have a history of malignancy. Common types of cancer that present with back pain include multiple myeloma, lymphoma, leukemia, spinal cord tumors, primary vertebral tumors and prostate cancer. Back pain is present in 29% of patients with systemic cancer. Unlike other causes of back pain that commonly affect the lumbar spine, the thoracic spine is most commonly affected. The pain can be associated with systemic symptoms such as weight loss, chills, fever, nausea and vomiting. Unlike other causes of back pain, neoplasm-associated back pain is constant, dull, poorly localized and worsens with rest. Metastasis to the bone also increases the risk of spinal-cord compression or vertebral fractures that require emergency surgical treatment. Autoimmune
Inflammatory arthritides such as ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis and systemic lupus erythematosus can all cause varying levels of joint destruction. Among the inflammatory arthritides, ankylosing spondylitis is most closely associated with back pain because of the inflammatory destruction of the bony components of the spine. Ankylosing spondylitis is common in young men and presents with a range of possible symptoms such as uveitis, psoriasis and inflammatory bowel disease. Referred pain
Back pain can also be referred from another source.