Not Just Back Pain: The Overlooked Symptom That Revealed Cancer

Introduction

Can lower back pain be trying to tell you something more serious?

Most people assume it’s a muscle strain, a disc issue, or simply part of aging. But sometimes, persistent back pain is a warning sign—one that can be easily missed until it’s too late.

In this clinical case, we’ll explore how a common symptom masked a life-threatening condition, and how integrative thinking could have changed everything.

The Case: A Hidden Danger Behind Chronic Pain

A 60-year-old man presented with chronic lower back pain. The discomfort was vague, dull, and localized to the lumbar region—specifically around L3 to L5. It wasn’t radiating, there was no sciatica, and no pain down the legs. It just lingered.

With no history of trauma and a desk-based lifestyle, it was easy to assume this was a classic case of degenerative disc disease or mechanical back pain.

So he was treated accordingly—for months.

He went through:

• Acupuncture

• Massage therapy

• Chiropractic care

• Physical therapy

• Pain medications

• Even spinal injections

All under the assumption that this was a musculoskeletal issue.

But the pain never improved.

Overlooked Symptoms and Missed Connections

Throughout this time, the patient showed no fever, no weight loss, and no night sweats—nothing alarming that pointed to a systemic disease.

There was, however, one minor complaint: mild urinary symptoms. Slightly increased frequency and some discomfort while urinating.

At age 60, this was brushed off as benign prostatic hyperplasia (BPH)—common in aging men. No red flags were raised.

But that was the mistake.

Two Symptoms—One Diagnosis, Not Two

Doctors treated the urinary issue and back pain as unrelated. They never considered that these two could be connected.

The pain continued.

After five months, an MRI was finally ordered.

That’s when everything changed.

The True Cause: A Missed Cancer Diagnosis

The MRI revealed metastatic vertebral lesions.

His spine was riddled with cancer.

And the source?

Bladder cancer.

The cancer had spread to the lumbar vertebrae, causing persistent pain that was wrongly attributed to aging and disc degeneration.

This wasn’t a simple back problem. It was bone metastasis—and it had been silently progressing all along.

Clinical Takeaway: The Danger of “Concept Bias”

This case illustrates a cognitive trap known as concept bias—a common cause of missed or delayed diagnoses.

Concept bias happens when healthcare providers rely too heavily on familiar diagnoses. They fit new symptoms into existing assumptions rather than questioning the bigger picture.

In this case:

• The back pain was labeled as degenerative disc disease (common at 60)

• The urinary symptoms were labeled as BPH (also common at 60)

Both were reasonable assumptions—but they were wrong. The patient’s true condition was systemic and serious.

Why Integrative Medicine Matters

An integrative approach asks deeper questions.

A provider trained to consider both conventional and holistic perspectives may have asked:

• Why isn’t the pain responding to musculoskeletal treatments?

• Could there be a systemic or internal organ cause?

• Should imaging be done sooner?

By thinking beyond surface symptoms, an integrative practitioner could have identified this red flag earlier—and potentially altered the patient’s outcome.

Final Thought

Chronic pain isn’t always what it seems.

When symptoms persist despite treatment, it’s a call to look deeper—not just at the body, but at the whole person.

Let this be a reminder to all clinicians—especially acupuncturists and integrative providers—to trust your instincts and stay curious. Sometimes, what appears to be “just back pain” may be the body’s cry for help.

Written by Dr. H (Hashemipour)
Clinical Ph.D. in Integrative East-West Medicine, MD (IMG), Licensed Acupuncturist (NY)
Professor in Integrative Medicine
Helping bridge holistic and modern medicine for safer, smarter healthcare.
📺 YouTube: Dr.H Med