How is Acute Low Back Pain Diagnosed?

Question: How is Acute Low Back Pain Diagnosed?

If you’ve had lower back pain for less than 6 weeks, it’s considered to be "acute". It’s a good idea to get your spine checked before the 6-week mark, as early treatment may help you avoid a long-term chronic back problem, also known as persistent pain.

Answer:

When you go to the doctor for your back pain, she will conduct a medical interview (called a history) and a physical exam. The information she gathers at this appointment will help her diagnose your pain by placing you into one of three general categories:

• Non-specific low back pain
• Pain directly involving nerves for example, spinal stenosis or a herniated disc
• Other causes, also called "red flags." These are serious conditions that may have back pain as a symptom. An example might be a tumor or infection. If you have a red flag, your doctor will order diagnostic tests to try to get to the root of the problem.

Your treatment plan and the decision for any further testing will be determined based on the category you are in.

Researchers have found that personality, attitude and social conditions play a big role in determining how long the pain will last, and how severe it gets. So, don’t be surprised if your doctor asks you questions related to this. After listening to your answers in the medical interview, she will then evaluate your risk of developing chronic back pain and disability.

Your back problem may or may not require diagnostic testing, such as an x-ray or MRI. If you are sent for one of these tests, keep in mind that they are meant to help the doctor pinpoint locations in your spine that show damage or changes (called lesions) corresponding to your symptoms. But because most back problems have no specific cause, they often cannot be detected on a film. The exceptions are: You have nerve symptoms, spinal stenosis, or -- based on your history and physical exam -- the doctor thinks a serious underlying health problem is causing your pain. Also, if your doctor is considering surgery or injection medication as possible treatments, you may need diagnostic testing.

_{Sources:
Fritz, J.M., Delitto, A., Erhard, RE. Comparison of classification-based physical therapy with therapy based on clinical practice guidelines for patients with acute low back pain: a randomized clinical trial. Spine. Jul. 2003.
Back pain, acute, low. BMJ Clinical Evidence.
Michigan Quality Improvement Consortium. Management of acute low back pain. Southfield (MI): Michigan Quality Improvement Consortium; 2008 Mar.
Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, Owens DK, Clinical Efficacy Assessment Subcommittee of the American College of Physicians, American College of Physicians, American Pain Society Low Back Pain Guidelines Panel. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007 Oct 2.}