Intended for healthcare professionals

Rapid response to:

Clinical Review

Low back pain

BMJ 2004; 328 doi: (Published 06 May 2004) Cite this as: BMJ 2004;328:1119

Rapid Response:

Re: 1% of back pain caused by neoplasm?


I read with interest Dr Robert Smith’s comment
questioning the percentage of patients presenting in
primary care with ‘back’ pain due to a neoplasm in his
response to Dr Speed’s (1) statement that 1% of
people presenting with back pain in primary care have
a neoplasm. Before I retired as Clinical Director of the
Multidisciplinary Spinal Pain Unit at Townsville General
Hospital, Queensland, my colleagues and I ran a
prospective investigation on 1775 patients (2) who
presented with spinal pain syndromes and who
underwent a routine clinical history, physical
examination, appropriate imaging and laboratory tests
to determine the percentage of patients presenting with
various conditions. We found malignancies in 0.6% of
the patients (bone (1); neural (2); Pancoast (1);
prostatic (5); pancreatic (1); myeloma (2)). I no longer
have the breakdown of figures for just low back pain.
However, it would appear that Dr Speed’s comment
that 1% of people presenting with ‘back’ pain in primary
care have a neoplasm, may be somewhat high.

(1) Speed C. ABC of Rheumatology. Low Back Pain.
BMJ 2004; 328: 1119-1121. (8 May.)

(2) Giles LGF, Muller R, Winter GJ. Patient satisfaction,
characteristics, radiology, and complications
associated with attending a specialized
Government-funded Multidisciplinary Spinal Pain Unit. J
Manipulative Physiol Ther 2003; 26: 293-299.

Competing interests:
None declared

Competing interests: No competing interests

24 July 2004
Lynton G Giles
Consultant Clinical Anatomist
Brisbane, Queensland, Australia, 4068