Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: September 18, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Differential Diagnosis for Backache and High ESR

Single Most Likely Diagnosis

  • Degenerative Disc Disease or Mechanical Back Pain: This is often the most common cause of backache, and a high ESR (Erythrocyte Sedimentation Rate) can be seen in chronic inflammation. However, the high ESR might also suggest an inflammatory component or another underlying condition.

Other Likely Diagnoses

  • Ankylosing Spondylitis: A form of arthritis that primarily affects the spine, although other joints can also be involved. It causes inflammation of the spinal joints (vertebrae) that can lead to severe, chronic pain and discomfort.
  • Rheumatoid Arthritis: While it primarily affects the hands and feet, rheumatoid arthritis can also cause back pain and has a significant inflammatory component that would elevate the ESR.
  • Osteoarthritis: Especially when considering the spine, osteoarthritis can cause back pain. The inflammation associated with osteoarthritis can lead to an elevated ESR.

Do Not Miss Diagnoses

  • Spinal Epidural Abscess: A serious condition that requires immediate medical attention. It's an infection in the spine that can cause back pain, fever, and elevated inflammatory markers like ESR.
  • Cauda Equina Syndrome: A condition that occurs when the nerves in the spinal canal are compressed, leading to pain, numbness, and potentially permanent nerve damage if not promptly treated.
  • Multiple Myeloma: A type of blood cancer that can cause back pain due to bone lesions and would also elevate the ESR due to the production of abnormal proteins.
  • Spinal Metastases: Cancer that has spread to the spine can cause back pain and elevated ESR due to the body's inflammatory response to the tumor.

Rare Diagnoses

  • Sarcoidosis: A disease characterized by the growth of tiny collections of inflammatory cells (granulomas) in any part of the body — most commonly the lungs and lymph nodes — but can also affect the spine, leading to back pain and elevated ESR.
  • Relapsing Polychondritis: A rare disease that causes inflammation of the cartilage and can affect various parts of the body, including the spine, leading to back pain and elevated inflammatory markers.
  • Paget's Disease of Bone: A chronic condition that can result in enlarged and misshapen bones due to abnormal bone destruction and regrowth, which can cause back pain if the spine is involved.

Related Questions

Does a patient undergoing a celiac plexus block need to hold heparin (unfractionated heparin/low molecular weight heparin)?
What are normal pulmonary artery pressures?
How are Adderall (amphetamine and dextroamphetamine) withdrawal symptoms managed?
What is the best medication for treating constipation?
Can I add prazosin and naltrexone to a patient's current regimen of trazodone (trazodone) and lexapro (escitalopram), and would gabapentin be a suitable addition as well?
What is the best treatment approach for a backache that responds to corticosteroids (Non-Steroidal Anti-Inflammatory Drugs, NSAIDs)?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question