There is no single diagnostic study of choice for the diagnosis of back pain. Back pain is a symptom of an underlying condition, emphasis should be made in identifying the etiology. The diagnostic plan should include, a detailed history, physical examination, identification of red flags, imaging (preferably an MRI) and laboratory evaluation (CBC, ESR, CRP, ANA, RF, LDH, uric acid, HLA-B27).

• There is no single diagnostic study of choice for the diagnosis of back pain.
• Back pain is a symptom of an underlying condition, emphasis should be made in identifying the etiology.
• The diagnostic plan should include:^[1][2]
  • Detailed history
  • Physical examination
  • Identification of red flags^[3][4][5][6]
    • Bowel incontinence
    • Bladder incontinence
    • Progressive weakness in legs
    • Sleep interrupted due to severe back pain
    • Fever
    • Depression
    • Unexplained weight loss
    • Back pain due to trauma
    • Increased back pain in patients with osteoporosis or multiple myeloma
    • Repetitive intense exercise involving lumbar extension
    • Long term corticosteroid use (can cause fractures)
  • Imaging, if indicated (preferably an MRI)
  • Laboratory evaluation (CBC, ESR, CRP, ANA, RF, LDH, uric acid, HLA-B27)