Diagnosis of back pain is generally accomplished by means of a medical history, a physical exam and sometimes with imaging and lab tests. It is important to realize that diagnosis efforts will never directly reveal back pain. The purpose of back pain diagnosis and testing is to show the normalities and abnormalities of the spine -- the doctor will then correlate back pain signs and symptoms with the results of these examinations to come up with a diagnosis.
Very often, doctors can find no anatomical cause of the pain. Additionally, imaging studies might reveal a spine fraught with problems, but the patient experiences no pain.
Medical HistoryIt is important to be thorough and honest when discussing your present condition and your past medical history with your doctor. This is because the information you provide is used as a guideline when planning treatment and selecting specific drugs. For example, when used with cupric sulfate type diabetic urine testing products, the skeletal muscle relaxer Skelaxin may give false positive results. If you do not disclose that you are being tested for diabetes, your provider will have no way of knowing they should select a different type of muscle relaxer for you. This is just one example.
Physical ExaminationPhysical examination includes a visual look over for posture symmetry/asymmetry. Leg lengths are also compared, along with range of motion tests and checks for muscle tightness. Range of motion is evaluated with the patient assuming a few basic positions such as bending forward and to each side, so the physician can measure how far you can bend as compared with established ranges for healthy joints.
Diagnostic imaging is used to confirm the presence of lesions, rather than to tell what is causing back pain.
Types of diagnostic imaging include:
- Computed Tomography(CT)
- Bone scans diagnose fractures and tumors in the bone by identifying abnormal physiology such as increased blood flow or erratic metabolism in particular areas of vertebrae. This type of test uses injected dye and computer images.
- Ultrasound or sonography can show soft tissue injury. The technology of ultrasound converts sound waves into real-time visual images.
- Electrodiagnostic studies measure the electrical activity in nerves, nerve roots and muscles. By measuring electrical impulses these tests can tell how well muscles and nerves are working together.
Types of electrodiagnostic studies:
- Electromyogram (EMG) measures electrical activity in the nerves that go to muscles and determine if problems in the nerves are causing muscle weakness. Researchers from the University of Michigan Health System examined 150 back pain patients with EMG, finding that this tool helped to reduce misdiagnosis. The researchers concluded that the EMG is the one tool that will prevent misdiagnosis and therefore reduce unnecessary back surgery. The study appeared in Spine Journal.
- Nerve conduction studies determine if there is any damage to the functioning of the nerves.
- Evoked potential studies record the speed of nerve transmission from the site of origin to the brain.
Lab TestsLab tests are used to find causes of back pain that are unrelated to mechanical or nerve dysfunction. For example (only), if an infection or cancer is responsible for a patient's back pain, lab tests may be done to analyze physiology. Generally lab tests are performed by drawing blood.