Diagnosis and tests for back pain

Most episodes of back pain last a few days, and are completely resolved within a few weeks.However, there are a few warning signs that may need immediate evaluation: 1. Your back pa

By: Dr Smarajit Chakrabarty | | Updated: November 24, 2014 5:28 pm

Treatment of lower back pain Most episodes of back pain last a few days, and are completely resolved within a few weeks.However, there are a few warning signs that may need immediate evaluation: Also Read - test featured image size 11

1. Your back pain persists beyond a few days Also Read - test ppost ACC

2. Your back pain awakens you at night Also Read - Do you get back pain after eating? Here are some possible causes

3. You have difficulty controlling your bowels or bladder

4. You have a fever, chills, sweats, or other signs of infection

5. Any other unusual symptoms

5 Types of Doctors that one might need to see for Back Pain

The Family Doctor or GP: Family doctors see a range of health problems including back and neck pain. If you have a serious problem, your doctor will probably order diagnostic tests, refer you to a specialist and/or help with short-term pain management by prescribing medication.

The Emergency Room Doctor: It is time to go to the emergency room if you have problems with bowel or bladder function, or if your legs grow progressively weaker. These are the symptoms of Cauda Equine Syndrome, one of the few life-threatening back problems.

The Orthopaedic Surgeon: An orthopaedic surgeon is one who specializes in problems of the musculoskeletal system, from head to foot, including the spine. He might address conditions such as ruptured discs, sciatica, scoliosis and other causes of low back pain.

The Rheumatologist: A rheumatologist will treat arthritis and musculoskeletal problems, including back and neck problems such as spinal stenosis, and spinal arthritis. They also treat diseases that are related to back pain such as osteoporosis, fibromyalgia and other forms of back pain.

The Neurosurgeon: A neurosurgeon specializes in diseases and conditions of the central nervous system, and the nerves that branch out from the spine. He might perform surgery on the brain, the spinal cord or on the spine itself. While they do provide non-surgical management of back pain, you may be referred to one after exhausting all your conservative care options, rather than before.

Diagnosis of Back Pain:

The doctor you visit for your back pain takes a medical history, administers a physical exam, and sometimes uses additional imaging and lab tests. It is important to realise 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 assess the spine for problems. The doctor will then correlate signs and symptoms with the results of tests and examinations to come up with a diagnosis.

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’ or indicators of more serious medical conditions like cancer during the history.

5 Symptoms that your doctor will particularly be on the look-out for are:

Pain shooting down the legs
Early morning stiffness
Continuous or episodic pain
Pain increasing with coughing or sneezing
Intensity and pattern—the when of back pain

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 the patient in positions that correlate with known back conditions to see if they reproduce the pain, tests for muscle strength, atrophy and tightness, 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.

Very often your doctor will use imaging and lab tests to help relate conditions of the spine with your stated symptoms.

MRI of the Lumbar Spine: MRIs use powerful magnets and 3D computer images to capture detailed views of the spine, from many angles. They can rule out tumors and infections and are particularly useful for viewing the discs and nerve roots, and the condition of the spinal nerves.

X-rays of the Lumbar Spine: X-Rays are an inexpensive way to view the condition of bones and joints. Here, they are used to see if a vertebra has been damaged. X-Rays, where indicated, are generally the first test that a doctor orders.

DXA Scan for BMD: These are used to screen for and detect the early stages of osteoporosis, a condition defined by a decreased density of normal bone.

Blood Tests: A Complete Blood Count, including the ESR, S. Uric Acid, RA Factor, CRP, HLAB27, amongst others.

Ultrasound of the Abdomen and Pelvis: Especially to rule out gynaecological problems, some of which can also cause back pain.

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