Because the causes of back pain are often complex and multi-factorial, it is often more difficult to get an accurate diagnosis for back pain than for other medical conditions. While some spinal diagnoses are relatively straightforward (such as tumors, infections, or fractures), for many conditions there is little agreement among spine specialists about a diagnosis.
However, getting an accurate diagnosis of the cause of back pain is critical, because different diagnoses will require very different treatment approaches. And the sooner an accurate diagnosis is made, the sooner the patient can find an appropriate treatment for pain relief and to improve his or her ability to enjoy everyday activities.
This article explains how to get an accurate diagnosis, including an explanation of several common issues patients face when trying to get a diagnosis for their underlying cause of their back pain.
The medical diagnosis, also called a clinical diagnosis, serves to identify the underlying cause of the patient’s back pain.
Medical professionals determine the cause of the patient’s pain through a combination of the following two to three steps:
A Review of the Patient’s Medical history
The physician will spend time asking the patient a series of questions, such as a description of when the low back pain, sciatica, or other symptoms occur, a description of how the pain feels, what activities, positions, or treatments make the pain feel better and more.
A Physical Examination
The physicians will conduct a thorough physical exam of the patient, such as testing nerve function and muscle strength in certain parts of the leg or arm, testing for pain in certain positions, and more. Usually, this series of physical tests will give the spine professional a good idea of the type of back problem the patient has.
Diagnostic Testing (Maybe)
After the physician has a good idea of the source of the patient’s pain, a diagnostic test, such as a CT scan or an MRI scan, may be recommended in order to confirm the presence of the suspected cause of the patient’s pain. For example, if a disc problem is suspected, an imaging test can provided a detailed image showing the location and size of the herniated disc and affected nerve roots.
The most common diagnostic tests include:
- X-rays provide detail of the bone structures in the spine, and are used to check for instability (such as spondylolisthesis), tumors, and fractures.
- CT scans, which are essentially a very detailed X-ray, take cross section images of the body. They provide excellent bony detail and are also capable of imaging for specific conditions, such as a herniated disc or spinal stenosis.MRI scans are particularly useful to assess certain conditions by providing detail of the disc (such as for degenerative disc disease, isthmic spondylolisthesis) and nerve roots (such as for herniated discs or spinal stenosis). MRI scans are also useful to rule out tumors or spinal infections. Before an MRI scan is performed, the physician usually has a good idea of what he or she is looking for, and the scans are most commonly used for injection planning, pre-surgical planning, such as for a microdiscectomy, spinal fusion, or other types of back surgery.