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Getting an Accurate Back Pain Diagnosis

Getting an Accurate Back Pain Diagnosis

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.

Diagnostic Process

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 painsciatica, 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.
  • Despite all the advances in medical care for back pain, there is still a lot that science does not yet understand. In particular, the causes of back pain can be very complex, making it difficult at times to get an accurate diagnosis. Ideally, taking a proactive approach in the process of getting a diagnosis can help patients get on the road to recovery sooner and with fewer detours.

  • See Introduction to Diagnostic Studies for Back Pain
  • Terminology Problems

    Many terms are used to describe spinal disorders, and healthcare practitioners often use terms differently. For example, the same spinal disc abnormality might be described as a herniated disc, pinched nerve, bulging disc, protruding disc, slipped disc, or prolapsed disc. There is no agreement in the medical field as to the precise definition of any of these terms. Often the patient hears his or her diagnosis referred to in different terms by various health professionals and wonders what the real diagnosis is.

    Additionally, conventional medical terminology can sometimes be misleading for back pain sufferers. As an example, degenerative disc disease is not really a disease, but rather a degenerative condition that at times can produce pain from a damaged disc. While everyone’s discs degenerate as they age, not everyone will develop painful symptoms.

  • See What Is Degenerative Disc Disease? and What's a Herniated Disc, Pinched Nerve, Bulging Disc...?.
  • Diagnostic Tests Do Not Provide a Diagnosis

    Rather than focus on the MRI or other test terminology referring to spinal anatomy, it’s most helpful for patients to focus on understanding the clinical diagnosis for their back problems. It should be kept in mind that many medical terms (such as herniated disc) refer to radiographic findings seen on a CT scan or MRI scan, but the tests cannot determine what is actually causing the patient’s back pain.

Article Written by J. Talbot Sellers, DO
Article Website: http://www.spine-health.com/treatment/diagnostic-tests/getting-accurate-back-pain-diagnosis