The diagnosis of low back pain, particularly when attempting to identify a specific pain generating tissue, pathology or anatomical structure, remains a controversial discussion. The dominant view is that for 90% of patients with low back pain, their pain cannot be attributed to a specific pathology or structure and thus should thus be classified as non-specific low back pain. However, some believe that sub classification of non-specific low back pain is possible through using the clinical presentation, clinical assessment and diagnostic imaging in order to identify a nociceptive source.

 

Potential sources of low back pain include the disc, facet joint, and sacroiliac joint. Clinically, it remains a challenge to identify the nociceptive source of low back pain within primary care due to the lack of availability of validated tests and the invasive nature of most reference standards such as disc provocation procedures or diagnostic blocks. However, there remains an interest to identify simpler diagnostic tests that could be used in order to identify the nociceptive source of low back pain. A previous review was conducted in 2007 which identified a relatively low number of studies that had investigated the diagnostic accuracy of tests. The review found that some tests such as MRI evidence of a high intensity zone and disc degeneration, and the centralization phenomenon could be informative to identify the disc as the pain generating source. Furthermore, a combination of sacroiliac joint provocation tests were found to modestly increase the likelihood of the sacroiliac joint causing the pain.