Back Pain.

Last updated Tuesday, January 25, 2005

Diagnosis and evaluation

Diagnosis

Regardless of what type of doctor you see, there are some things you can expect your doctor to do during your visit.

Your doctor first will ask you a number of questions, the most common of which are listed as follows:

1. What are your symptoms--that is, what aches or pains do you have?
2. Exactly where is the pain?
3. Where is the pain the most severe?
4. When did the pain begin? How long have you had it?
5. Did something specific cause your back pain, such as an accident or injury?
6. What home treatments have you used?
7. Were you under any additional stress when the pain began?
8. Do you have any other health problems?
9. What kind of work do you do?
10. In what types of recreational activities do you participate?

Think about these ahead of time so you can answer them easily. You also may have questions you'd like to ask the doctor. As you think of questions at home, jot them down and take them to the appointment.

Next, your doctor will give you a physical exam. During the exam, the doctor may perform any of the following:

• observe your muscles and joints
• ask you to sit and lie down
• ask you to move your back in different positions
• observe and feel the area of most pain
• and/or check to see if other areas of your body are tender or painful (such as the kidneys, intestines or other organs)

If the doctor can identify the likely cause of your back pain at this point, no further tests will be needed.

Diagnostic tests

If the doctor needs more specific information, he or she may ask you to undergo one or more of the following lab tests:

X-ray

Studies show that in many cases of routine back pain, X-rays may not initially be necessary. However, the signs and symptoms will determine what type of study should be done. In certain cases, X-rays might indicate that pain is due to:

• injury in one or more of the back bones
• a tumor in the spine
• a deformity in the spine
• ankylosing spondylitis

Only a few people with lower back pain need a CT (computerized axial tomography) scan. If your doctor advises one, a special machine takes an X-ray scan of the area. A computer turns this scan into a three-dimensional view of the back. This helps the doctor see if there is a ruptured disc that can't be seen on regular X-rays. Other conditions that a CT scan can help detect are spinal stenosis, tumors and infections of the spinal cord.

MRI

MRI (magnetic resonance imaging) is another way to make very clear pictures of parts of the spine. The MRI does not use X-rays or radioactive dyes. It can provide dearer pictures of soft tissues such as muscles, cartilage, ligaments, tendons and blood vessels, in addition to bone structure.

Myleogram

During a myelogram, a special liquid dye called contrast medium is injected into the spinal canal. X-rays are then taken of the area. The contrast medium can make problem areas show up more dearly on the X-ray. A doctor may order a myelogram to detect problems such as spinal stenosis or spinal cord tumors. If surgery is being considered, particularly for a person who has had a serious back injury, many neurosurgeons will require a myelogram beforehand.

Bone Scan

During a bone scan, a very small amount of radioactive liquid is injected into a vein and concentrates in the bones for a short time. A special radioactive detecting machine then will scan the area of concern to produce a picture. Occasionally bone scans are done to look for damage or tumors in the bones themselves. However, back pain is rarely due to diseases of the bones.

Electrodiagnostic studies

Electrodiagnostic studies are used to help confirm the presence of nerve compression in the spine. An electrodiagnostic study consists of two tests. One is an electrical test, which is designed to study nerve conduction. In this test the nerve is given an electrical stimulation, and the speed of the impulse is measured. The other test is a needle test called an electromyogram, or EMG. The purpose of this test is to study the muscles for primary disease or for the effect of nerve compression on the muscle. The compression is especially seen in herniated discs or spinal stenosis.

Blood tests

If your doctor orders blood tests for you, a laboratory technician will carefully draw a small amount of blood from a vein in your arm, which then will be tested in the laboratory. Any one of the following blood tests may be ordered:

• erythrocyte sedimentation rate (sed rate)
• hematocrit and hemoglobin
• white blood cell count
• HLA B-27 test
• chemical profile (SMAC)

Health care team

It often is difficult for doctors to find the exact cause of back pain, especially since there are so many possible causes.

If the cause is unclear, your family doctor may suggest that you see an orthopaedist, rheumatologist, neurosurgeon, neurologist, physiatrist or other medical specialist for diagnosis.

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