The results of this review demonstrate that tests do exist that change the probability of the disc or SIJ ( but not the facet joint ) as the source of low back pain .
Clinical practice guidelines state that the tissue source of low back pain can not be specified in the majority of patients .
However , there has been no systematic review of the accuracy of diagnostic tests used to identify the source of low back pain .
The aim of this systematic review was therefore to determine the diagnostic accuracy of tests available to clinicians to identify the disc , facet joint or sacroiliac joint ( SIJ ) as the source of low back pain .
Centralization as a predictor of provocation discography results in chronic low back pain, and the influence of disability and distress on diagnostic power.
BACKGROUND CONTEXT The " central ization phenomenon " ( CP ) is the progressive retreat of referred pain towards the spinal midline in response to repeated movement testing ( a McKenzie evaluation ) . A previous study suggested that it may have utility in the clinical diagnosis of discogenic pain and may assist patient selection for discography and specific treatments for disc pain . PURPOSE Estimation of the diagnostic predictive power of central ization and the influence of disability and patient distress on diagnostic performance , using provocation discography as a criterion st and ard for diagnosis , in chronic low back pain patients . STUDY DESIGN / SETTING This study was a prospect i ve , blinded , concurrent , reference st and ard-related validity design carried out in a private radiology clinic specializing in diagnosis of chronic spinal pain . PATIENT SAMPLE Consecutive patients with persistent low back pain were referred to the study clinic by orthopedists and other medical specialists for interventional radiological diagnostic procedures . Patients were typically disabled and displayed high levels of psychosocial distress . The sample included patients with previous lumbar surgery , and most had unsuccessful conservative therapies previously . OUTCOME MEASURES DIAGNOSIS results of provocation discography . INDEX TEST The CP . Psychometric evaluation : Rol and -Morris , Zung , Modified Somatic Perception question naires , Distress Risk Assessment Method , and 100-mm visual analog scales for pain intensity . METHODS Patients received a single physical therapy examination , followed by lumbar provocation discography .  Sensitivity , specificity , and likelihood ratios of the CP were estimated in the group as a whole and in subgroups defined by psychometric measures . RESULTS A total of 107 patients received the clinical examination and discography at two or more levels and post-discography computed tomography .  Thirty-eight could not tolerate a full physical examination and were excluded from the main analysis . Disability and pain intensity ratings were high , and distress was common . Sensitivity , specificity , and positive likelihood ratios for central ization observed during repeated movement testing for pain distribution and intensity changes were 40 % , 94 % , and 6.9 respectively . In the presence of severe disability , sensitivity , specificity , and positive likelihood ratios were 46 % , 80 % , 3.2 and for distress , 45 % , 89 % , 4.1 . In the subgroups with moderate , minimal , or no disability , sensitivity and specificity were 37 % , 100 % and for no or minimal distress 35 % , 100 % . CONCLUSIONS Central ization is highly specific to positive discography but specificity is reduced in the presence of severe disability or psychosocial distress
The results of this review demonstrate that tests do exist that change the probability of the disc or SIJ ( but not the facet joint ) as the source of low back pain .
Clinical practice guidelines state that the tissue source of low back pain can not be specified in the majority of patients .
However , there has been no systematic review of the accuracy of diagnostic tests used to identify the source of low back pain .
The aim of this systematic review was therefore to determine the diagnostic accuracy of tests available to clinicians to identify the disc , facet joint or sacroiliac joint ( SIJ ) as the source of low back pain .