Objective: To review the disposition and outcome of patients with back pain seen in a neurology clinic, and determine the value of the neurologist’s input. Background: Back pain is a common cause of referral to the neurology clinic, but it is not clear how much the neurologist contributes to the care of such patients. Design/Methods: We reviewed all new patients and new consultations seen for the following reasons: low back pain; ‘sciatica’; ‘back and leg pain’, and ‘spinal stenosis’. Patients were evaluated by a single attending neurologist at a general neurology clinic over a 2-year period (January 1997 through December 1998). Results: During the 2-year period, there were 97 patients seen for the above reasons. The chief complaint was low back pain alone in 73, while it was combined with another symptom in 24 (leg pain in 18, buttock or hip pain in 6). Thirty-three patients were self-referred, 56 were referred by a healthcare professional, 3 were referred by attorneys, and the referral source was unclear in 5. Median age was (range 25–90) years. Forty-eight were males. Based on the clinical data (history and examination), clinical diagnoses were radiculopathy in 28, myelopathy in 2, uncomplicated spondylosis in 27, and other non-neurologic conditions in 45. Tests performed after the visit included X-rays in 31, CT in 1, MRI in 16, and EMG in 17. ‘Final’ diagnoses were radiculopathy in 29 patients, myelopathy in 2 (total neurologic n = 30), uncomplicated spondylosis in 27, and other non-neurologic diagnoses in 41 (total non-neurologic n = 67). The non-neurologic diagnoses included periarticular pain, bursitis, muscle strain, soft tissue injury, and vertebral compression fractures. Final dispositions in the non-neurologic group (n = 67) were: nonsteroidal anti-inflammatories (NSAIDs) in 34 patients; analgesics or muscle relaxants in 37; physical therapy for 19, and none (including rest and observation) for 22. Four patients were referred for epidural blocks. (Many patients had more than one final disposition.) Final dispositions in the neurologic group (n = 39) were: physical therapy (n = 9); NSAIDs (n = 12); analgesics or muscle relaxants (n = 12), and epidural blocks (n = 3). Three patients were referred for surgery, but only 1 had an operation. Conclusions: Of patients with back pain and related symptoms seen in a neurology clinic, about two thirds have non-neurologic conditions. These patients are usually treated symptomatically with medications, rest, and physical therapy, all of which could be managed by primary care physicians. In the neurologic group, the vast majority is treated in the same way as the non-neurologic group. When more specific measures are needed, such as surgery or pain management procedures (e.g., epidural blocks), then the patients could be evaluated directly by the proper specialist (pain management or spine surgery) rather than the neurologist. The neurologist’s input does not significantly affect the diagnosis or the management, so that the neurologist appears to have no useful role in the management of such patients.

Heliovaara M, Sievers K, Impivaara O, et al: Descriptive epidemiology and public health aspects of low back pain. Ann Intern Med 1989;21:327–333.
Frymoyer JW, Pope MH, Constanza MC: Epidemiologic studies of low back pain. Spine 1980;5:419–423.
Barton JE, Haight RO, Marsland DW, Temple TE: Low back pain in the primary care setting. J Fam Pract 1976;3:363–366.
Cypress BK: Characteristics of physician visits for back symptoms: A national perspective. Am J Public Health 1983;73:389–395.
Choler U, Larsson R, Nachemson A, Peterson LE: Back pain. SPRI Rep 1985;188:1–100.
Schappert SM: Office visits to neurologists: United States, 1991–92. Adv Data 1995;267:1–19.
Carey TS, Garrett J, Jackman A, McLaughlin C, Fryer J, Smucker DR: The outcomes and costs of care for acute low back pain among patients seen by primary care practitioners, chiropractors, and orthopedic surgeons. The North Carolina Back Pain Project. N Engl J Med 1995;333:913–917.
Andersson GB, Lucente T, Davis AM, Kappler RE, Lipton JA, Leurgans S: A comparison of osteopathic spinal manipulation with standard care for patients with low back pain. N Engl J Med 1999;341:1426–1431.
Schroth WS, Schectman JM, Elinsky EG, Panagides JC: Utilization of medical services for the treatment of acute low back pain. J Gen Intern Med 1992;7:486–491.
Deyo RA, Diehl AK: Cancer as a cause of back pain: Frequency, clinical presentation, and diagnostic strategies. J Gen Intern Med 1988;3:230–238.
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