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Diagnosing Back Pain Symptoms

How Physicians Diagnose Back Pain

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Updated August 31, 2010

Diagnosis of back pain is usually made after a doctor takes a medical history, gives a physical exam, and sometimes uses additional imaging and lab tests. It is important to realize that diagnosis will probably not directly reveal the cause of back or neck pain. The purpose of an exam and tests for back pain is to show the normalities and abnormalities of the spine. The doctor will then correlate signs and symptoms with the results of tests and 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 History

The medical history is like an interview between you and your doctor. In the medical history, your doctor is looking for information she or he can use in the hunt to identify the nature or cause of your problem. Doctors also look for "red flags" during the history. Red flags are indicators of serious medical conditions, such as cancer.

Examples of valuable information for the doctor include: location and intensity of pain, pain patterns, what relieves it and what makes it worse, how the pain affects your functioning and more. You will also be asked about any other medical conditions you may have now or had in the past. This includes questions about psychological problems, especially depression. Research shows that psychological factors have a strong association with both the onset of back pain and the development of chronic back pain; therefore, questions about it are included in the medical history.

It 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 during the medical history is used as a guideline when planning treatment and selecting specific drugs.

Physical Examination

The physical exam is used by the doctor to follow up on the information gleaned from the medical history. Here the doctor uses a number of specific manually administered tests to assist her or him in ruling out or confirming a diagnosis. Examples of tests used in the exam include placing you in positions that correlate with known back conditions to see if they reproduce your pain, tests for muscle strength, atrophy and tightness, and joint range of motion, and reflex testing. Sometimes the results of the exam combined with the results from the history indicate to the doctor the need for further testing.

Diagnostic Tests

In some cases imaging and lab tests are done to help relate conditions of the spine with your stated symptoms. There are a number of imaging tests, but the MRI is often what the doctor will order, especially if she or he suspects sciatica, or if you previously had neurological problems, back surgery, or to rule out Cauda Equina Syndrome, cancer or infection. With the age of technology upon us, medical establishments rely more on these types of tests to diagnose back pain.

While the tests can be revealing, some think that doctors depend on them to the exclusion of the most reliable diagnostics tools -- that of the physical exam. These critics believe that the tests relegate back pain into only what can be seen on a film, when in reality, there are many factors, from fitness level, to psychological factors, and more, that create back pain in most patients. The critics also believe that history taking and physical exam skills are being lost by those doctors who rely almost exclusively on tests.

Sources:
Institute for Clinical Systems Improvement (ICSI). Assessment and management of chronic pain. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2005 Nov

Woby, S.R., Roach, N.K., Urmston, M., Watson, P.J., "The relation between cognitive factors and levels of pain and disability in chronic low back pain patients presenting for physiotherapy." Eur J Pain 2007 Mar 12.

Hasenbring, M. Hallner, D., Klasen, B, Psychological mechanisms in the transition from acute to chronic pain: over or underrated? Schmerz 2001 Dec: 15(6)

Bradley WG Jr, Seidenwurm DJ, Brunberg JA, Davis PC, DE La Paz RL, Dormont D, Hackney DB, Jordan JE, Karis JP, Mukherji SK, Turski PA, Wippold FJ, Zimmerman RD, McDermott MW, Sloan MA, Expert Panel on Neurologic Imaging. Low back pain. [online publication]. Reston (VA): American College of Radiology (ACR); 2005.

Deyo, R. A., Patrick, D.L. Hope or Hype: The Obsession With Medical Advances and the High Cost of False Promises. AMACOM Books. New York 2005

Gould, H.J. III, M.D., Ph.D. (2007). Understanding Pain. Saint Paul, MN: Demos.

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