PAIN-BACK PAIN, INVESTIGATIONS

SUMMARY

1. Establish the diagnosis or differentials. Exclude red flags.

2. Identify the what imaging is appropriate:
- MRI: for radicular pain and radiculopathy
- Whole-body bone scan/CT spectroscopy: to investigate mechanical pain, age-related issues and to exclude red flags
- CT: better to investigate facet and bony abnormalities
- Dynamic X-rays: to assess for instability and movement of hardware in patients who have undergone fusion procedures

3. Establish when it is appropriate: urgent if you wish to exclude red flags.

4. Why is it required? This is a synthesis of: age, mechanism of pain (nociceptive, neuropathic, nociplastic, radicular), site of pain and possible red flags.

Reference(s)

Cifu, D.X. (2020). Braddom’s physical medicine and rehabilitation. Elsevier. Get it on Amazon.
Cuccurullo, S. (2019). Physical medicine and rehabilitation board review. New York: Demosmedical. Get it on Amazon.
O’Young, B., Young, M.A. and Stiens, S.A. (2008). Physical Medicine and Rehabilitation Secrets. Mosby. Get it on Amazon.