Getting an accurate back pain diagnosis

Back pain diagnostic techniques

Because the causes of back pain can be very complex, it is often more difficult to get an accurate diagnosis for back pain or neck 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 back pain diagnosis is made, the sooner the patient can find an appropriate treatment to for pain relief and rehabilitation.

The following points provide helpful information regarding several common issues patients face when getting trying to get a diagnosis for their back pain  or neck pain.

Confusing terminology about back pain and spinal disorders

There are many terms to describe spinal disorders, and different 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 different practitioners 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.

Diagnostic tests do not provide a diagnosis for back pain

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.

An accurate clinical diagnosis for the patient’s back pain or neck pain is based on correlating the findings of the diagnostic tests (such as an MRI), with the patient’s specific symptoms and the physician’s findings from a complete physical exam.

Diagnostic studies are focused on confirming a lesion

Diagnostic tests are used to confirm an anatomical lesion as a cause of back or neck pain. They are particularly useful to pinpoint the source and extent of the lesion (such as a herniated disc), which in turn assists in the diagnosis and development of an appropriate treatment plan. 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, 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 pre-surgical planning, such as for a Microdiscectomy, spinal fusion, or other types of back surgery.

There are a number of other imaging and electrical studies that may also be used to help diagnose the cause of a patient’s back pain, and some injections are used for diagnostic purposes as well as for pain relief.

Some diagnostic tests for back problems are controversial

There is little that all physicians agree on when it comes to diagnosing and treating back pain. For example, a discogram, which is an injection technique used to determine if a specific disc is generating pain, is quite controversial. Some spine surgeons believe that a discogram is the only way to determine if the disc is painful, and some believe that the test is not useful. As with most controversies, the truth is some where in between, and it probably is a useful test when done by an experienced discographer and for the right reasons. As with all other tests, the results of the discogram need to be carefully correlated with other tests and the patient’s symptoms.

There are other tests that are also controversial and are used variably by different practitioners. These include EMG’s (electromyography), selective nerve root blocks, and facet blocks. While there is not complete agreement about when the tests should be done in the diagnosis of back pain and back problems, the important thing is that the results need to be correlated with the patient’s symptoms and other tests.

When no anatomical reason for the back pain can be found

While it is difficult to believe, despite a battery of diagnostic tests many times there is no anatomical reason that can be found that can account for a patient’s back pain or neck pain. However, if there is no anatomical reason for the patient’s pain, the pain is still real and needs to be managed.

Pain medicine specialists focus on providing diagnosis, treatment, and techniques for people with chronic pain that can’t be addressed through surgery. Many integrated pain clinics also provide support resources, such as a support group and counseling, as well as medical treatments to manage the back pain.

The causes of back pain are complex

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.

By: J. Talbot Sellers, DO
February 25, 2003