Abstract
BackgroundTo describe the evaluation, treatment, management and referral of two patients with back pain with an eventual malignant etiology, who were first thought to have a non-organic biomechanical disorder.Clinical featuresThe study was a retrospective review of the clinical course of two patients seen by a chiropractor in a multi-disciplinary outpatient facility, who presented with what was thought to be non-organic biomechanical spine pain. Clinical examination by both medical and chiropractic physicians did not indicate the need for radiography in the early course of management of either patient. Upon subsequent re-evaluation, it was decided that certain clinical factors required investigation with advanced imaging.In one instance, the patient responded to conservative care of low back pain for nine weeks, after which she developed severe pain in the pelvis. In the second case, the patient presented with signs and symptoms consistent with uncomplicated musculoskeletal pain that failed to respond to a course of conservative care. He was referred for medical therapy which also failed to relieve his pain. In both patients, malignancy was eventually discovered with magnetic resonance imaging and both patients are now deceased, resulting in an inability to obtain informed consent for the publication of this manuscript.ConclusionIn these two cases, the prudent use of diagnostic plain film radiography did not significantly alter the appropriate long-term management of patients with neuromusculoskeletal signs and symptoms. The judicious use of magnetic resonance imaging was an effective procedure when investigating recalcitrant neuromusculoskeletal pain in these two patients.
Highlights
To describe the evaluation, treatment, management and referral of two patients with back pain with an eventual malignant etiology, who were first thought to have a non-organic biomechanical disorder.Clinical features: The study was a retrospective review of the clinical course of two patients seen by a chiropractor in a multi-disciplinary outpatient facility, who presented with what was thought to be non-organic biomechanical spine pain
[3] The rate of radiography performed by doctors of chiropractic in the United States has decreased since the release of the 1998 Job Analysis of Chiropractic from the National Board of Chiropractic Examiners
[7] Interestingly, most of these patients have normal lumbar spine radiographs or age-related degenerative changes that do not correlate with the presence, absence, or severity of pain. [7,8,9,10,11] In some instances, the use of plain film radiography may be associated with poorer clinical outcomes
Summary
Standard evidence-based medicine guidelines and best practices were utilized in making clinical decisions about the care for these patients, without any unwanted or adverse side effects. Both patients were eventually diagnosed with malignancy, this approach did not significantly alter the appropriate longterm management of these patients who presented to a chiropractor with neuromusculoskeletal signs and symptoms. Manipulation provided some positive outcomes in these patients, suggesting that these patients had both uncomplicated/non-organic biomechanical spine pain along with malignancies In both cases, plain film radiographs were initially thought to be of little help, as there was a low index of suspicion for cancer. The judicious use of MRI was an effective procedure when investigating recalcitrant neuromusculoskeletal pain in the patients in our series
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
