mid back painMr R, a 56 years old carpenter, presented to the clinic with constant mid back pain of 2 weeks duration. The pain was felt deep in the mid back and was worsening since its onset. Mr R confirmed sleepless nights and no relief obtained from over-the-counter medication. The night before the consultation, Mr R’s wife had to call the mobile A&E because of the pain; they prescribed strong painkillers and advised Mr R to visit a chiropractor because the pain was suspected to be an ‘trapped nerve’.

On examination, no routine or special tests managed to reproduce Mr R’s pain, however he was in a considerable amount of discomfort and it was decided to take an x-ray of his mid back.

On screening Mr R’s radiograph, it was noted a subtle para spinal swelling and the absence of a pedicle. Both findings were enough to suspect a pathological, metastasis, origin of his complaint.

Mr R was immediately referred to the local hospital with a copy of the physical examination findings and the x-ray report. He was admitted with urgency and booked for a spinal surgery the day after.

It is not unusual for chiropractors to spot lesions and to pinpoint conditions often missed by other health professionals. This case outlined the importance to focus on the entire entity, rather than concentrating only on the patient’s symptoms