Is it true that the cause of 80% of back pain is unknown?
There are a lot of people with back pain, but have you heard the saying that “over 80% of
back pain is unexplained?”
Even if imaging tests such as X-ray and MRI are performed to investigate the cause of low
back pain, the cause cannot be identified in more than 80% of cases.
I believe many people have heard such statements. The reason for their widespread use
was the “Medical Guidelines for Lumbar Spine Disorders,” published in 2012 under the
supervision of the Japanese Orthopedic Association and the Japanese Society of Lumbar
Low back pain whose cause can be identified by image examination is called “specific back
pain”, and back pain whose cause cannot be specified is called “non-specific back pain”.
In “Medical Guidelines for Lumbar Spine Disorders 2012”, it was written that
“In the case of low back pain without lower limb symptoms, it is difficult to make an
accurate pathoanatomical diagnosis in 85% of cases.”
In other words, the guidelines stated that 85% of low back pain without lower limb
symptoms such as leg pain and numbness are non-specific low back pains whose cause
cannot be determined.
Is it possible to diagnose in more than 75% of cases?
The remark that “non-specific low back pain accounts for 85% of cases” took on a life of its
own, spreading the impression that the cause of most low back pains is unknown. But is it
really because the cause of 85% of low back pains is actually unknown?
Actually, in the revised second edition of the “Medical Guidelines for Lumbar Spine
Disorders” issued in May 2019, it is written that “diagnosis is possible in 75% or more of
It had been said that more than 80% of low back pains had unknown causes, but it was
greatly reduced to less than 30% of cases. What explains this?
An orthopedic surgeon can make a diagnosis with careful examination
The basis for stating “85% of non-specific back pains” in the first version of the “Medical
Guidelines for Lumbar Spine Disorders 2012” was a paper published in academic journals
in Europe and the United States. However, the paper was based on information from
general practice physicians in the United States, and was not the result of an examination
by an orthopedic specialist who is familiar with the treatment of low back pain.
Therefore, it may be possible to make an accurate diagnosis in more cases if a specialist
conducts a careful examination and assessment. The survey conducted in Japan is
“Yamaguchi Prefecture Low Back Pain Study”.
This was designated for 323 back pain patients who visited the orthopedic clinic in
Yamaguchi prefecture for the first time between April and May 2015.
First of all, lumbar vertebra/l fractures and lumbar disc herniation with lower limb
symptoms, lumbar spinal stenosis, infection, ankylosing spondylitis, internal medicine,
urology and gynecology, which have traditionally been called “specific back pain”
Twenty-one percent were classified as having an obvious cause, such as back pain from a
disease. This percentage is about the same as what has been said so far.
However, the remaining patients who were classified as having “non-specific low back
pain” were carefully examined by an orthopedic surgeon, and the cause was found in 72%
of the patients who were initially classified as “non-specific low back pain”. The specialists
found the source.
In other words, ultimately, 78% of all lumbago patients could be diagnosed, and 22% were
classified as “unknown”.
Back pain may be hiding a serious illness.
Based on the results of this “Yamaguchi Prefecture Back Pain Study”, the revised “Medical
Guidelines for Lumbar Spine Disorders ” states that “the premise that ‘85% of back pain is
non-specific’ needs to be reconsidered”.
Some people who have low back pain may think, “I won’t know the cause even if I do go for
an examination anyway.” But do you understand that the idea that “80% of the causes are
unknown” is an exaggeration?
And, most importantly, back pain may hide serious conditions such as cancer, compression
fractures, abdominal aortic aneurysms, or gynecological and urological diseases. In order
to confirm that you do not have such a disease, it’s important to have a medical
examination at once.
① Medical Prime Takanawa
The Takanawadai Orthopedic Surgical Clinic is located on the 5th floor of Medical Prime
Takanawa. Please feel free to contact us if you have a backache.
② Medical Prime Shinkawa
The “Hatchobori Sato Clinic” has just opened on the 6th and 7th floors of Medical Prime
Shinkawa. The 6th floor is for orthopedics, and the 7th floor is for women’s medical and
obstetrics. If you have a problem with low back pain, please feel free to consult with
③ Medical Prime Kanda
The “Tokyo Kanda Orthopedic Clinic” will open on the 3rd floor of Medical Prime Kanda in
August. Please feel free to contact us if you have a backache.