I admit my father is a bit of a complainer. He’s had back pain for so long, we’ve stopped listening to him complain about it. But now we found out that there may be something seriously wrong with him. Shouldn’t the doctor have been able to see this sooner than later?

Low back pain (LBP) can be very difficult to sort out. There are many possible causes and the symptoms are often vague or too subtle to identify. For many people, there is a significant psychologic or emotional overlay masking the true cause.

Experts who study the best way to handle patients with LBP have published clinical decision rules (CDRs). These rules or guidelines help physicians diagnose and treat LBP patients. The idea is to make as specific a diagnosis as possible and then direct treatment at that problem.

Some CDRs focus strongly on psychologic and social factors. It’s possible to overlook more serious neurologic pathology. It isn’t until the condition has progressed (gotten worse) that the correct diagnosis is made.

Researchers are trying to come up with a CDR that can be used with all LBP patients. Such a CDR would help identify the underlying problem no matter what the cause. Recently, a group from New Zealand published a report that neurologic syndromes aren’t always included in CDRs.

CDRs will continue to be modified and improved as more information is found out about LBP. Having a more accurate CDR will help doctors in the future to identify which patients are at risk for a more serious form of LBP.