Diagnosing back pain
Physical examination and medical history
Your doctor will take a medical history, and will likely ask about the frequency, duration and nature of the pain (whether it is piercing, throbbing, burning, etc); when it began; whether it was triggered by an event, such as lifting something heavy; what worsens the pain (e.g. coughing, walking) and what relieves it (e.g. lying down, exercise). Tell your doctor about any previous back pain episodes and injuries involving your back, neck or hips.Your doctor will then give you a full physical examination.
Most cases of back pain will not require complex tests for initial assessment and treatment. However, if pain is severe and not responding to treatment, or if you have significant leg pain, some imaging tests may be necessary. These may include the following:
- X-rays can help show bone alignment, and the presence of degenerative joint disease, tumours, infection or injury in some cases. Plain X-rays will not show soft tissues such as the lumbar discs or nerves.
- Magnetic resonance imaging (MRI) or computerised tomography (CT) scans generate images that help reveal conditions involving the soft tissues e.g. herniated discs. MRIs can also help detect non-spinal causes of back pain, including infection and cancer.
- Bone scan: a radioactive substance (tracer) is injected into a vein to help detect bone tumours or compression fractures caused by osteoporosis.
- Discography: discs suspected of being the source of pain are injected with dye and X-rayed. This technique is generally used to identify the location of the injured disc in patients undergoing back surgery.
- Myelography: a dye injected into the spinal canal shows up herniated discs or other lesions on X-rays. This has largely been replaced by CT and MRI scans.
- Electrodiagnostic studies: electrical tests, such as EMG (electromyography) are used to study nerve conduction pathways, and can confirm nerve compression caused by conditions such as herniated discs or stenosis.
