It’s the darker side of our psyche that creeps in during quiet moments of contemplation that can sow seeds of anxiety. As an Advanced Practice Physiotherapist treating spinal pain, Adam Brown of Cornerstone Physiotherapy in Toronto says he hears this question more often than you would think. Some mention it casually, as if joking, but years of experience have taught him that in every joke lies a very real source of anxiety. And given that anxiety worsens pain, it is worth tackling this concern head on.
It should be said that this is not meant to be advice about your specific back problem. If you are struggling with back pain, the best thing to do is make an appointment to be assessed by an experienced physiotherapist. That being said, the more you know about the subject, the more you will get out of that assessment.
Can Cancer Cause Back Pain? Yes.
Is It Common? NO
In fact one large study conducted by Deyo and Diehl found that only about 0.66% of patients who presented to their doctor with severe back pain had cancer. And they found that there were reliable ways to predict which ones required testing. More on that later.
Is Back Pain Common? YES!
Run-of-the-mill, excruciating and horrible back pain is very common. It is estimated that over 80% of us will deal with low back pain at some point in our lives. It’s one of the most common orthopaedic problems that people see their pain management doctor for.
How Do You Know If Your Back Pain Needs More Testing?
Here in Toronto, and in fact throughout Canada we know that our amazing public health system has limited resources. So clinicians try to ensure that they are ordering tests intelligently to reduce waste. This can be frustrating for patients seeking testing for their own peace of mind. But if you understand the process, perhaps that peace can be achieved without the unnecessary MRI.
Serious pathology like cancer, infection or inflammatory disease behave differently than mechanical back pain. So by taking a detailed history and seeking answers to some specific questions, a physiotherapist can determine if you need to start doing specific exercises, or if you need to see your doctor for testing.
Here are some of the features of serious pathology that tell an experienced Physiotherapist that more investigation may be warranted.
- Unintentional recent weight loss. 10lbs in the last 6 months without trying may be significant
- Fevers and Night Sweats
- Unrelenting constant pain that is not affected by a change of position
- Pain that is worse at night – with no relief from a change of position.
- A past history of Cancer
- No improvement despite participating in a treatment program
It is important to note that having just one of these features does not mean you have a serious problem. Some varieties of back pain have unrelenting pain for a while. It is the combination of two or more of these things that starts to become relevant. If you have a back problem that has many of the features listed above, you should see your doctor. They may order an x-ray and/or some blood work depending on your specific answers to their questions. Rest assured that even amongst those people who need to have further testing, the majority of them have very manageable problems. MANY issues can cause back pain, and few of them are really serious.
It is also important to know what typical mechanical back pain looks like. There are several symptom patterns that cover the majority of mechanical back problems. Did your pain start when you bent forward to pick up or lift an object? Or with a sneeze? Or a change/increase in physical activity? Is your pain worse after sitting for prolonged periods? Do your symptoms tend to improve if you change positions frequently and walk around a bit? This is not an exhaustive list, but they are hallmarks of some of the common types of back pain that physiotherapists see every day. They also can serve as a strong clue that what your dealing with is a normal orthopaedic injury rather than a life threatening pathology.
Adam says that after 18 years of assessing and treating people with severe back pain, only a handful have had cancer. Fully understanding how to identify serious pathology is an important part of what his team of physiotherapists do. So the next time your back pain gives you that sense of impending doom, make an appointment to talk with an experienced Physio. Not only will you get peace of mind, you will get treatment and a plan to get rid of your pain!