Back pain: the primrose path--a case report.

In the evaluation of patients older than 50 with severe back pain and chronic simple anemia, the diagnosis of multiple myeloma must be considered. Due to the age group affected, degenerative changes on spinal films may be misdiagnosed as osteoporosis, and anemia may be attributed to iron deficiency. These errors can be avoided in more than 99% of the cases of multiple myeloma by ordering a serum protein electrophoresis (SPE). Abnormal SPE patterns include monoclonal gammopathy and hypogammaglobulinemia. In the detection of multiple myeloma, magnetic resonance imaging has been found superior to plain radiograph, computed tomography and bone scan.