Diagnosing Low Back Pain of Disc, Sacroiliac Joint or Facet Joint Origin

Diagnosing Low Back Pain of Disc, Sacroiliac Joint or Facet Joint Origin

Diagnosing Low Back Pain of Disc, Sacroiliac Joint or Facet Joint Origin

Most clinical practice guidelines recommend general treatment approaches for low back pain, including exercise, medication or manual therapy. When studied, these interventions typically demonstrate small effect sizes and there is little to no information on how to individualize these treatments for patients.

The diagnosis of low back pain, particularly when attempting to identify a specific pain generating tissue, pathology or anatomical structure, remains a controversial discussion. The dominant view is that for 90% of patients with LBP, their pain cannot be attributed to a specific pathology or structure and thus should thus be classified as non-specific LBP. However, some believe that sub classification of non-specific low back pain is possible through using the clinical presentation, clinical assessment and diagnostic imaging in order to identify a nociceptive source.

Potential sources of low back pain include the disc, facet joint, and sacroiliac joint. Clinically, it remains a challenge to identify the nociceptive source of LBP within primary care due to the lack of availability of validated tests and the invasive nature of most reference standards such as disc provocation procedures or diagnostic blocks. However, there remains an interest to identify simpler diagnostic tests that could be used in order to identify the nociceptive source of LBP. A previous review was conducted in 2007 which identified a relatively low number of studies that had investigated the diagnostic accuracy of tests. The review found that some tests such as MRI evidence of a high intensity zone and disc degeneration, and the centralization phenomenon could be informative to identify the disc as the pain generating source. Furthermore, a combination of sacroiliac joint provocation tests were found to modestly increase the likelihood of the sacroiliac joint causing the pain.

Many studies have been conducted since that previous review and as a result, the aim of this paper was to update the review to understand the current state of the literature regarding the accuracy of diagnostic tests available in primary care to identify the disc, sacroiliac joint, and facet joint as the source of LBP.

RESEARCH REVIEW: “Diagnosing Low Back Pain of Disc, Sacroiliac Joint or Facet Joint Origin”

This paper was published in eClinicalMedicine (2023) and this Review is posted in Low Back Pain, Clinical Testing & Procedures and the 2023 Archive.

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