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Questions Doctors Ask About Low Back Pain

Sometimes doctors have as many questions about back pain as patients do. Could this patient really have a tumor? Should I order an X-ray? Would an MRI be better? What advice should I give the patient about bedrest or activity? Should I send him to physical therapy or to a chiropractor?

In this article, Dr. J. Katz from Harvard Medical School offers answers to these and other questions often asked by physicians treating low back pain (LBP) patients.

Tumors and infection as a cause of LBP should always be kept in mind. The physician must watch for red flags pointing to a more serious problem. These include previous history of cancer, fever, weight loss, and constant pain. Or the patient can't find a comfortable position, and the symptoms just don't go away no matter what is tried.

For the patient with nonspecific LBP, activity is better than bedrest. The patient should be encouraged to get back to daily and work activities as soon as possible. X-rays or other imaging studies aren't needed at first. If there are red flags or the patient doesn't get better in a couple of months, then further testing is advised.

There is a time and place for physical therapy or chiropractic care. Studies support the use of chiropractic for acute, nonspecific LBP. The use of chiropractic for spinal stenosis, disc problems, or chronic LBP is unclear at this time. Physical therapy is helpful in restoring motion and improving strength. A supervised exercise program can help prevent future problems.

The author also discusses the use of steroids and surgery for several types of back problems and reviews the differences between spinal stenosis and herniated discs. Physicians who can recognize signs and symptoms of each condition will have a better idea of how and when to treat each patient.


Jeffrey N. Katz, MD. Low Back Pain: 12 Questions Physicians Often Ask. The Journal of Musculoskeletal Medicine. March 2006. Vol. 23. No. 3. Pp. 154-160.

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*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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