Back Pain – Diagnosing the Cause of Your Low Back Pain
A complete medical history and physical exam can usually identify any dangerous conditions or family history that may be associated with back pain.
During the exam, your doctor will ask you to describe the onset, site, and severity of the pain; duration of symptoms and any limitations in movement; and your history of previous episodes or any health conditions that may be related to your pain. The doctor will examine your back and perform neurological tests to determine the cause of the pain and the appropriate treatment. Blood tests and/or imaging studies may be ordered to help diagnose tumors or other possible sources of pain.
The following are diagnostic methods used to confirm the cause of low back pain:
- X-ray images. X-ray imaging includes conventional and enhanced methods to help diagnose the cause and site of back pain. A conventional X-ray looks for broken bones or an injured vertebra, but masses of tissue, such as injured muscles and ligaments, or painful conditions, such as a bulging disc, are not visible on conventional X-rays. X-ray imaging is a quick, non-invasive, and painless procedure that is performed in a doctor’s office or clinic.
- Discography. Discography involves the injection of a special contrast dye into a spinal disc that is believed to be causing low back pain. The dye outlines damaged areas on x-rays taken after the injection. Discography is often suggested for patients who are considering lumbar surgery or whose pain has not responded to conventional treatments.
- Computed tomography (CT). This is a quick and painless process used when a ruptured disc, spinal stenosis, or damage to the vertebrae is suspected to be the cause of low back pain. X-rays pass through the body at various angles and are detected by a computerized scanner to produce two-dimensional slices of the internal structures of the back. A CT scan is a diagnostic test that is usually done in an imaging center or hospital.
- Magnetic resonance imaging (MRI). An MRI is used to evaluate the lower back for bone degeneration or injury or disease in tissues and nerves, muscles, ligaments, and blood vessels. The scanning equipment creates a magnetic field around the body strong enough to temporarily realign water molecules in tissues. Radio waves are then passed through the body to detect the “relaxation” of the molecules in a random alignment and trigger a resonant signal at different angles within the body. A computer processes this resonance into a three-dimensional image or a two-dimensional “slice” of the tissue that is scanned. Difference between bone, soft tissue, and fluid-filled spaces by their water content and structural properties. An MRI is a non-invasive procedure often used to identify a condition that requires immediate surgical treatment.
- Electrodiagnostic procedures. Electrodiagnostic procedures include electromyography (EMG), nerve conduction studies, and evoked potential (EP) studies. EMG evaluates electrical activity in a nerve to detect if muscle weakness is the result of injury or a problem with the nerves that control the muscles. With EMG, very fine needles are inserted into muscles to measure electrical activity transmitted from the brain or spinal cord to a particular area of the body. Nerve conduction studies involve the use of two sets of electrodes placed on the skin over the muscles. The first set of electrodes gives the patient a mild shock to stimulate the nerve to a particular muscle. The second set of electrodes records electrical signals from the nerve. From this information, the doctor can determine if there is nerve damage. PD testing also involves two sets of electrodes: one set to stimulate a sensory nerve and the other set on the scalp to record the speed of nerve signal transmissions to the brain.
- Good scans. Bone scans are used to diagnose and monitor infections, fractures, or disorders in the bones. A small amount of radioactive material is injected into the bloodstream so that it accumulates in the bones, particularly in areas with abnormalities. Scan-generated images are sent to a computer to identify areas of irregular bone metabolism or abnormal blood flow, and to measure levels of joint disease.
- thermography. Thermography uses infrared sensing devices to measure small changes in temperature between the two sides of the body or the temperature of a specific organ. It can be used to detect the presence or absence of nerve root compression.
- Ultrasound images. Also called ultrasonography or ultrasonography, ultrasound uses high-frequency sound waves to obtain images of the inside of the body. The echoes of the sound waves are recorded and displayed as a visual image in real time. Ultrasound images can show tears in ligaments, muscles, tendons, and other soft tissue masses in the back.
