Tests for nonorganic back pain

Several tests are useful in differentiating between organic and non-organic back pain (e.g. that caused by depression or complained of by a known malingerer).

Magnuson's method (the 'migratory pointing' test)

1. Request the patient to point to the painful sites.

2. Palpate these areas of tenderness on two occasions separated by an interval of several minutes, and compare the sites.

Between the two tests divert the patient's attention from his or her back by another examination. Paradoxical straight leg raising test

Perform the usual straight leg raising test. The patient might manage a limited elevation, for example 30°. Keep the degree in mind. Ask the patient to sit up and swing the leg over the end of the couch. Distract attention with another test or some question, and then attempt to lift the straight leg to the same level achieved on the first occasion. If it is possible, then the patient's response is inconsistent.

Burn's 'kneeling on a stool' test

1. Ask the patient to kneel on a low stool, lean over and try to touch the floor.

2. The person with non-organic back pain will usually refuse on the grounds that it would cause great pain or that he or she might overbalance in the attempt.

Patients with even a severely herniated disc usually manage the task to some degree. The axial loading test

1. Place your hands over the patient's head and press firmly downward (Fig 33.13).

2. This will cause no discomfort to (most) patients with organic back pain.

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