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NEUROLOGY 1987;37:134
© 1987 American Academy of Neurology

Back pain in the cancer patient

An algorithm for evaluation and management

Russell K. Portenoy, MD, Richard B. Lipton, MD and Kathleen M. Foley, MD

Department of Neurology (Drs. Portenoy and Lipton), Albert Einstein College of Medicine, Bronx, NY; and the Department of Neurology, Cornell University Medical Center, and Memorial Sloan-Kettering Cancer Center (Dr. Foley), New York, NY.

Epidural spinal cord compression is common in patients with metastatic cancer. Back pain is usually the first symptom and may be present for months before neurologic abnormalities occur. A favorable outcome depends on early diagnosis and treatment. For the management of this problem, we propose an algorithm that begins with the treatment of patients who need emergency care and proceeds with an orderly approach to the evaluation of less urgent cases. The central elements include the criteria for myelography and the rational use of corticosteroids, radiation therapy, and surgery.

Address correspondence and reprint requests to Dr. Portenoy, Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx. NY 10461.

Received June 11, 1985. Accepted for publication April 15, 1986.




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