Diagnosis of Back Pain

Doctors use various tools to help diagnose the possible cause for your back pain, which helps determine the best treatment plan.

Medical and Family History

Your doctor will ask questions about your medical and family history to help determine if an injury or underlying medical condition is the source for the back pain. Some questions your doctor may ask:

• Can you describe your pain? (e.g. sharp, aching, burning)
• Where is the exact location of your back pain?
• When did the pain start and how long have you had the pain?
• What were you doing when you first noticed the pain?
• How severe or bad is the pain?
• What makes the pain worse or better?
• Does chronic pain run in your family (such as arthritis or back pain)?

Your doctor may ask you to rate your pain on a scale from 1 to 10 to gauge the severity of the pain and talk to you about your ability to perform activities of daily living.

Physical Exam

Your doctor will likely perform a physical exam, which may include:

• Examining your spine and posture to look for changes in the bony structure.
• Asking you to bend or lift your legs to determine how movement affects your pain.
• Testing your reflexes, muscle strength, and sensation.

Imaging and Blood Tests

Most people do not need additional testing; however, sometimes doctors order tests to rule out a specific cause for your pain or to confirm a cause for your back pain. Your doctor may order the following.

• X-rays only show bones and can help diagnose:
  • Broken bones or fractures.
  • Changes due to aging.
  • Changes in the alignment of the spine.
• MRI (magnetic resonance imaging) uses energy from a powerful magnet to produce signals that create a series of cross-sectional images. These images or “slices” are analyzed by a computer to produce an image of the back. MRI can help diagnose damage or disease of the soft tissues, such as the discs, ligaments, and nerve roots in and around the spine.
• Computerized axial tomography (CAT) uses a scanner to take images of the back at different angles. The images are analyzed by a computer to create three-dimensional views of the back. As with MRI, CAT scans help diagnose problems with the spinal canal and the surrounding tissues.
• Electrophysiological tests, such as an electromyography or EMG, which helps measure the electrical activity in muscle. This test helps doctors check for problems with the muscles and nerves.
• Bone scans use small amounts of radioactive materials to help doctors see more details in the spine, such as fractures and infections.
• Blood tests help identify a possible cause for the back pain, such as inflammatory or medical disorders.

Treatment of Back Pain

Doctors treat back pain with various options, including medications, nonsurgical treatments, and surgical treatments.

Medications

• Over-the-counter pain relievers taken by mouth or applied to the skin.
• Anti-inflammatory drugs taken by mouth to relieve pain and inflammation.
• Muscle relaxants for some types of chronic back pain from muscle tension.
• Anti-inflammatory or numbing injections for certain types of back pain, such as for pain that travels down the leg due to nerve compression or irritation.
• Neuromodulatory agents that affect how the nervous system processes pain.
• Prescription pain relievers for severe acute back pain.

Other Treatments

• Use cold packs to help relieve some back pain and hot packs to increase blood flow and promote healing in the muscles and tissues of the back.
• Avoid bedrest; instead, limit activities or exercise that cause pain. Gradually increase physical activity as tolerated.
• Get physical therapy to help strengthen the muscles that support the back, which can improve mobility, posture, and positioning. Strengthening exercises can also help decrease pain. Check with your doctor or physical therapist before starting any exercise routine.
• Lifestyle changes teach you to:
  • Move your body properly when performing daily activities, especially those involving heavy lifting, pushing, or pulling. Avoid any activities that cause or increase pain.
  • Practice healthy habits such as exercise, relaxation, regular sleep, healthy diet, and quitting smoking.
• Complementary and alternative treatments may help relieve pain. Some examples include:
  • Manipulation of the spine and nearby tissues. Professionals use their hands to adjust and massage the spine and muscles.
  • Transcutaneous electrical nerve stimulation (TENS) sends mild electrical pulses to the nerves through a device and electrodes or pads that are placed on the skin. TENS treatments are not always effective for reducing pain.
  • Acupuncture is a Chinese practice that uses thin needles that may relieve pain in some patients.

Surgical Treatments

Surgery for back pain may be suggested if all other treatments tried have not relieved your pain. However, not everyone is a candidate for surgery, even if the pain persists. The type of surgery your doctor recommends depends on the cause of your pain and your medical history. In addition, your surgeon will review the risks and possible benefits of the surgery or procedure.

• Laminectomy is a surgery that doctors perform to treat spinal stenosis by removing the bony spurs and the bone walls of the vertebrae. This helps to open up the spinal column and remove the pressure on the nerves.
• Discectomy and microdiscectomy are surgeries that remove part of a herniated disc to relieve pressure on a nerve root or the spinal canal. The only difference between the procedures is a microdiscectomy uses a smaller incision than the discectomy. Doctors may also include a laminectomy.
• Spinal fusion is a surgery that helps treat degenerative disc disease and spondylolisthesis by joining two or more vertebrae in the spine that have slipped from their normal position. During this procedure, the surgeon removes the disc between the vertebrae and uses bone grafts or metal devices to secure bones together.
• Foraminotomy is a surgery that cleans out and widens the area where the nerve roots leave the spinal canal. By opening up this area, the pressure on the nerves from spinal stenosis can be relieved.
• Disc replacement surgery replaces a damaged disc with a synthetic one. This procedure is limited to patients who do not have complicating factors.
• Laser surgery uses a needle that produces bursts of laser energy to reduce the size of a damaged disc. This relieves pressure on the nerves.
• Radiofrequency lesioning of the affected nerves blocks inputs of the pain signals outside the spinal cord from entering the spinal cord.
• Spinal cord stimulation stimulates the spinal cord with levels of electricity that are not felt and that can block some of the pain signals going from the spinal cord to the brain.

The recovery time from surgery depends on the type of procedure and your overall health. Research shows that surgery can be helpful for people with herniated discs, spinal stenosis, and spondylolisthesis.

Who Treats Back Pain?

Different types of health care providers treat back pain, depending on the cause:

• Pain specialists, who are physicians including anesthesiologists with specialized training in evaluation, diagnosis, and treatment of all different types of pain.
• Family or primary care doctors.
• Orthopaedists, who treat and perform surgery for bone and joint diseases.
• Neurologists, who treat disorders and diseases of the spine, brain, and nerves.
• Neurosurgeons, who perform surgery for disorders and diseases of spine, brain, and nerves.
• Physiatrists, who also treat disorders and diseases of the spine, brain, and nerves.
• Rheumatologists, who specialize in treating musculoskeletal diseases and autoimmune disorders.
• Physical therapists, who specialize in movement and strengthening muscles.

Prevention of Back Pain

You may be able to prevent back pain from overuse or improper body mechanics. The following recommendations can help you have a healthy back and lifestyle:

• Perform regular exercise that keeps your back muscles strong. Exercises that increase balance and strength can decrease your risk of falling and injuring your back or breaking bones. Exercises such as tai chi and yoga – or any weight-bearing exercise that challenges your balance – are good ones to try. Remember to warm up before exercise or other physical activities.
• Eat a healthy diet that includes enough calcium and vitamin D, nutrients that keep your spine strong.
• Maintain a healthy weight. Being overweight can put unnecessary and injury-causing stress and strain on your back.
• Practice good posture and avoid slouching. Try to remember to support your back when sitting or standing.
• Avoid lifting heavy items whenever possible. If you do lift a heavy item, use your leg and abdominal muscles instead of your back.