Metastatic cancer mimicking mechanical low back pain: a case report

Abstract

Objective and Importance: The purpose of this report is to describe the clinical course of a patient referred to physiotherapy (PT) for the treatment of low back pain who was subsequently diagnosed with metastatic non-small cell carcinoma of the lung. Clinical Presentation: A 48-year old woman was referred to PT for the evaluation and treatment of an insidious onset of low back pain of 2 month duration. The patient did not have a history of cancer, recent weight changes, or general health concerns. The patient's history and physical examination were consistent with a mechanical neuromusculoskeletal dysfunction and no red flag findings were present that warranted immediate medical referral. Intervention: Short-term symptomatic improvements were achieved using the treatment-based classification approach. However, despite five PT sessions over the course of 5 weeks, the patient did not experience long-term symptomatic improvement. On the sixth session, the patient reported a 2-day history of left hand weakness and headaches. This prompted the physiotherapist to refer the patient to the emergency department where she was diagnosed with lung cancer. Conclusion: Differential diagnosis is a key component of PT practice. The ability to reproduce symptoms or achieve short-term symptomatic gains is not sufficient to rule out sinister pathology. This case demonstrates how extra caution should be taken in patients who are smokers with thoracolumbar region pain of unknown origin. The need for caution is magnified when one can achieve no more than short-term improvements in the patient's symptoms.

Most red flags for malignancy in low back pain guidelines lack empirical support: a systematic review

“…We found two systematic reviews presented in 5 articles [13][14][15][16][17]. Furthermore, we found 2 narrative reviews [10,18], 7 prospective cohort studies [19][20][21][22][23][24][25][26], 9 retrospective cohort studies often collecting data from medical records [27][28][29][30][31][32][33][34][35], and 8 case reports [36][37][38][39][40][41][42][43]. Six studies provided diagnostic test accuracy data related to red flags for detection of malignancy for patients with LBP and were included in the assessment of diagnostic accuracy using the QUADAS-2 (Table 1) [20,21,22,24,26,29].…”

“…We found five case reports. Patients were a 69-year-old man that visited a chiropractor with LBP after a twisting movement [39]; a 73-year-old lady with LBP and severe band like pain in the abdomen referred to a spine centre [40]; a 48-year-old women referred to physiotherapy for LBP [41]; a 15-year-old girl who visited the paediatric emergency department [42] and a 54-year-old man consulting the physiotherapist complaining of LBP after a motor vehicle accident [43]. In all cases, history taking and clinical examination did not reveal red flags that warranted medical referral.…”

Benefits and barriers to pediatric tele-urology during the COVID-19 pandemic

“…Prior to the COVID-19 pandemic, telemedicine was an under-utilized form of delivering health care in the field of pediatric urology [10]. Prior studies have demonstrated successful telemedicine encounters for post-operative visits as well as for prenatal consultations on urologic conditions, most commonly including urinary tract dilation [5e7].…”

Specialty Differences in Initial Evaluation of Patients With Non-Acute Musculoskeletal Pain

“…46 No specific blood test exists for detecting common MSK disorders, eg, low back pain, so it is therefore not surprising to see lower usage except for oncology where "MSK-like" pain can often manifest in the presence of bony metastases highly associated with breast, lung, and prostate cancer. 47 CBCs are ancillary tests that are routinely used to help detect conditions such as rheumatoid arthritis and the family of autoimmune rheumatic disorders. These latter populations are typically seen by rheumatologists, a specialty who were not categorized separately in the NAMCS public use files, and this may have ultimately impacted the accuracy of the prevalence of CBC tests across physician specialties.…”