Nonorganic back pain

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Like headache, back pain is a symptom of an underlying functional, organic or psychological disorder.

5 Preoccupation with organic causation of symptoms may lead to serious errors in the assessment of patients with back pain. Any vulnerable aching area of the body is subject to aggravation by emotional factors.

Depressed patients are generally less demonstrative than patients with extreme anxiety and conversion disorders and malingerers, and it is easier to overlook the non-organic basis for their problem.

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Fig. 33.12 Important primary malignancies to the spine. Note the difference between sclerotic and osteolytic metastases; multiple myeloma also causes osteoporotic lesions

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