Diagnosing the cause of back pain
When someone has back pain, it is most important to
- Initially, evaluate if the patient presents with common
back pain or a general disease that manifests in the back
(for example an infection, tumor or a metabolic dysfunction -
such as osteoporosis -). In over 95% of cases the pain is due
to common back pain.
- - Subsequently, if there is common back pain, it is wise to
determine the presence of signs of nerve compression and the specific
cause of pain, in order to establish the most adequate treatment
within the required time span.
To determine these factors, it is sometimes convenient to perform
radiological diagnostic testing -such as plain X-rays or magnetic
resonance imaging (MRI)-, biochemical tests -blood tests- or a test
of function -electromyogram- , all of which are described below.
But the most important sources of information are:
- The patient's medical history -inquiring about past medical
details, about onset, site and characteristics of pain, factors
that trigger or exacerbate pain, etc.-, and
- The outcome of a thorough physical examination -studying the
postures and movements that produce pain, sensitivity, reflexes
and strength, presence of nerve root compression signs, etc.-.
In fact, diagnostic test results, including the most sophisticated,
are only of value when they correlate with the information obtained
through clinical history and physical examination. For example,
two patients with a very similar image of disc herniation on MRI
should be treated in a completely different fashion if physical
examination was within normal limits in one case and in the other
case showed signs of nerve compression. It is a drastic error to
treat images instead of patients.
Some diagnostic tests are painful, others expose the patient to
important radiation and all signify considerable cost to the patient,
whether in terms of money, discomfort or wasted time. Clinicians
should only order them when the treatment is to be modified according
to test results or whenever the prognosis is to be adjusted.
The existing recommendations
based on scientific evidence state that if a patient has suffered
pain for less than 4 weeks, it is only recommended to obtain a clinical
history and a physical examination. Only if these suggest that pain
may be due to a different cause or when signs of severe nerve compression
are present, is it recommended to perform diagnostic tests - X-rays,
MRI, blood tests, etc.-. Doing otherwise would be useless, since
test results would not change the patient's treatment in any case.
Besides medical history and
physical examination, the most
frequently used diagnostic procedures to determine the cause of
back pain are:
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Diagnostic tests
