Non Surgical Back Evaluation

How Is Back Pain Diagnosed?

Diagnosing the cause of back pain requires a medical history and a physical exam. If necessary, your doctor may also order medical tests, which may include x rays.

During the medical history, your doctor will ask questions about the nature of your pain and about any health problems you and close family members have or have had. Questions might include the following:

• Have you fallen or injured your back recently?
• Does your back feel better-or hurt worse-when you lie down?
• Are there any activities or positions that ease or aggravate pain?
• Is your pain worse or better at a certain time of day?
• Do you or any family members have arthritis or other diseases that might affect the spine?
• Have you had back surgery or back pain before?
• Do you have pain, numbness, or tingling down one or both legs?

During the physical exam, your doctor may:

• watch you stand and walk
• check your reflexes to look for slowed or heightened reflexes, either of which might suggest nerve problems
• check for fibromyalgia by examining your back for tender points, which are points on the body that are painful when pressure is applied to them
• check for muscle strength and sensation
• check for signs of nerve root irritation

Often a doctor can find the cause of your pain with a physical and medical history alone. However, depending on what the history and exam show, your doctor may order medical tests to help find the cause.

Following are some tests your doctor may order:

X rays: Traditional x rays use low levels of radiation to project a picture onto a piece of film (some newer x rays use electronic imaging techniques). They are often used to view the bones and bony structures in the body. Your doctor may order an x ray if he or she suspects that you have a fracture or osteoarthritis or that your spine is not aligned properly.

Magnetic resonance imaging (MRI): MRI uses a strong magnetic force instead of radiation to create an image. Unlike an x ray, which shows only bony structures, an MRI scan produces clear pictures of soft tissues, too, such as ligaments, tendons, and blood vessels. Your doctor may order an MRI scan if he or she suspects a problem such as an infection, tumor, inflammation, or pressure on a nerve. An MRI scan, in most instances, is not necessary during the early phases of low back pain unless your doctor identifies certain "red flags" in your history and physical exam. An MRI scan is needed if the pain persists for longer than 3 to 6 weeks or if your doctor feels there may be a need for surgical consultation. Because most low back pain goes away on its own, getting an MRI scan too early may sometimes create confusion for the patient and the doctor.

Computed tomography (CT) scan: A CT scan allows your doctor to see spinal structures that cannot be seen on traditional x rays. A computer creates a three-dimensional image from a series of two-dimensional pictures that it takes of your back. Your doctor may order a CT scan to look for problems including herniated disks, tumors, or spinal stenosis.

Blood tests: Although blood tests are not used generally in diagnosing the cause of back pain, your doctor may order them in some cases. Blood tests that might be used include the following:

• Complete blood count (CBC), which could point to problems such as infection or inflammation
  
  
• Erythrocyte sedimentation rate (also called sed rate), a measure of inflammation that may suggest infection. The presence of inflammation may also suggest some forms of arthritis or, in rare cases, a tumor
  
  
• C-reactive protein (CRP), another blood test that is used to measure inflammation, may indicate an infection or some forms of arthritis
  
  
• HLA-B27, a test to identify a genetic marker in the blood that is more common in people with ankylosing spondylitis (a form of arthritis that affects the spine and sacroiliac joints) or reactive arthritis (a form of arthritis that occurs following infection in another part of the body, usually the genitourinary tract)

It is important to understand that medical tests alone may not diagnose the cause of back pain. Often, MRI scans of the spine show some type of abnormality, even in people without symptoms. Similarly, even some healthy pain-free people can have elevated sed rates.

Only with a medical history and exam-and sometimes medical tests-can a doctor diagnose the cause of back pain. Many times, the precise cause of back pain is never known. In these cases, it may be comforting to know that most back pain gets better whether or not you find out what is causing it.