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How to diagnose back pain

What’s causing your aching back? These tests can help your doctor make the right diagnosis and speed your way toward relief.

Next to headaches, back pain is the most common neurological problem experienced in the United States. Medications such as anti-inflammatory drugs and physical therapy sessions help many people get relief from their back pain, but some need more help and turn to a specialist.

“We treat patients who need more than physical therapy and medications,” says Santiago Figuereo, MD, neurological surgeon and founder and medical director of the Miami Neurological Institute.

Relief from back pain symptoms starts with getting the correct diagnosis. Your doctor will begin by taking a complete history of your back pain symptoms before moving on to possible back pain causes, such as a damaged disk or a pinched nerve.

Preparing for Your First Office Visit

Your first appointment will include a physical exam, but one of the most important clues needed to determine your back pain causes comes from sharing a thorough history of your back pain symptoms with your doctor. Bring a detailed list of those symptoms with you and also be prepared to answer these questions:

  • How long have you had the back pain?
  • Is the pain just in your back or does it radiate into your leg or arm?
  • What makes the pain better?
  • What makes the pain worse?
  • Have you been treated for back pain previously?
  • Was treatment helpful?

Your doctor will probably ask about other symptoms that could be related to problems with the spine, Dr. Figuereo says. These questions may include:

  • Do you ever feel weakness, numbness, or tingling?
  • Do you ever experience urinary incontinence or urinary retention (trouble urinating)?

“Those are red flag symptoms that worry us for serious trouble of the spine,” Figuereo says.

Tests to Determine Back Pain Causes

Your doctor will perform a physical exam and order a number of tests to try to localize the cause of your back pain. Tests your doctor may order include:

  • MRI. Magnetic resonance imaging (MRI) uses a magnetic field and radio frequency to create a picture of bones, soft tissues, and organs. It gives your doctor a picture of your spinal cord, the nerves, and the discs of the spine, which are the most commonly affected structures in cases of back pain. With an MRI, your doctor can see if there’s serious damage to a disk or a pinched nerve, says Figuereo. But using an MRI scan is somewhat controversial, since some experts believe they often show abnormalities that aren’t related to pain.
  • X-rays. X-rays of the lumbar spine will reveal if there’s damage to bones from a fall or trauma. However, X-rays aren’t helpful for routine back pain that isn’t a result of trauma, Figuereo says.
  • CT scan. CT scans (or CAT scans) are more detailed X-rays that give a better picture of the anatomy of the bones, Figuereo says. They’re used to rule out major problems, but aren’t the most effective test, he adds.

Most of the time, people with new back pain symptoms will see an improvement down the road, Figuereo says. When this doesn’t happen, doctors can investigate further to get an idea of your back pain causes.

Written by Dr. Victor Marchione
| –> Arthritis | –> Published on February 8, 2017

Although you feel pain in your lower back, the origin of that pain may begin in the groin, thighs, knee, or buttocks. Unfortunately, determining the origin of pain can be a difficult task for many doctors, as symptoms can greatly overlap.

For this reason, a new article was published in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS) which outlines the identical symptoms between spine and hip pain, which can radiate to the lower back. It also goes into how doctors can better diagnose this type of pain.

Pain of the groin or difficulties getting out of a car or putting on shoes commonly originates in the hip. Buttocks pain or a tingling sensation will stem from the spine. Some patients, though, may experience what is known as hip/spine syndrome, where lower back pain doesn’t have a clear source of discomfort. An example of this is hip arthritis, where even though it affects the hip, more pressure is added to the lower back which results in lower back pain.

Article author Afshin Razi explained, “In these instances, similar or overlapping symptoms may delay a correct diagnosis and appropriate treatment.”

The article recommends that patients provide their health care provider with a detailed medical history and undergo an intensive physical examination that assesses gait, hip and back range of motion, posture, pelvis, lower limb and spinal alignment, loss of muscle, previous surgical scars, and limb-length discrepancies.

Dr. Razi continued, “Plain and advanced imaging studies and diagnostic injections also can be used to further delineate the primary problem and guide the appropriate sequence of treatment.”
Specific diagnosis for spine pain can include osteoarthritis, stress fracture, osteonecrosis of the hip, labral tear, disc herniation and pinched nerves, stenosis, and sacroiliac joint dysfunction.

Dr. Razi concluded, “Focusing on both the spine and the hip as potential causes of pain and disability may reduce the likelihood of misdiagnosis, and the management of conditions affecting the spine and/or hip may help reduce the likelihood of persistent symptoms.”

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How to diagnose back pain

Back pain is a very common complaint among adults. There are so many causes of back pain, it may take a process of elimination to get to the cause of the problem. In order to make a back pain diagnosis, a physician may do a variety of tests and complete a physical exam and medical history. Making an accurate back pain diagnosis is essential to getting effective treatment.

Determining the cause of back pain can be difficult in some cases. A detailed medical history and a physical are often the first step in back pain diagnosis. The physician will also ask about the type of pain. For instance, some people may have tingling back pain or radiating back pain.

The physician may ask when the pain started and how severe it is. Understanding the type of pain helps in making a back pain diagnosis. It’s also important to determine if a person is suffering from chronic back pain, which means it has been occurring for a while. Another classification is acute back pain, which means it has developed suddenly.

A physical exam will than be performed to check for any spinal abnormalities. A person’s reflexes will be checked. The physician will also test to determine if strength or range of motion has decreased. After an exam and medical history, various tests may be ordered, starting with an x-ray. An x-ray will take a picture of the bones in the back and may help determine if there are any fractures or tumors on the spine.

Often, a CT scan can provide more detail than an x-ray and may be needed in some cases. Another tool to help a doctor make a back pain diagnosis is a magnetic resonance imaging scan (MRI). The MRI uses magnets to produce images of the body. Because an MRI can create images from varied planes, it is sometimes helpful in determining the cause of back pain. It is important to note that an MRI can fail to detect ruptured spinal discs about 20 percent of the time.

Myelogram is one more diagnostic tool doctors use to determine the cause of back pain. It is a special type of x-ray using a dye injected into the spine. Although it was common in the past, it is not used as often now that magnetic resonance imaging is available. It still may be used with a CT scan in certain situations to help diagnose back pain. It is most often done if back surgery will be needed.