4 Big Reasons Why Back Pain Is Hard to Diagnose

For many back problems, getting a diagnosis and determining the best treatment can be surprisingly difficult.

See Back Pain Overview: A Guide for Understanding Back Pain

Herniated DiscHerniated discs and sciatic pain are usually correlated. Watch: Herniated Disc Video

For example, someone recently told me that he had been diagnosed with a lumbar herniated disc and radiculopathy. He was certain he had sciatica, but when he mentioned this to the doctor, the doctor didn't seem to think it was relevant. In reality, though, he only had one condition: a lumbar herniated disc. The herniated disc was causing the sciatica symptoms the patient was experiencing, and the medical term for sciatica is radiculopathy. So while it sounds like 3 issues, really only the herniated disc needs treatment.

See Lumbar Herniated Disc: What You Should Know

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Questions to Ask a Spine SurgeonHaving questions ready for your appointments can help the diagnostic process.
Video: Questions to Ask Your Spine Surgeon

Four challenges to understanding your back pain

Here are four common issues that help illustrate what makes it so difficult to understand your back pain:

  1. Diagnostic challenges. As many of you already know, getting your back problem diagnosed correctly can be a challenge. To start, spine specialists don't always agree on a diagnosis, and many diagnostic tests have limited value and may even be controversial. Bottom line, there is no test that can provide an accurate back pain diagnosis, although quite a bit is known about certain conditions (e.g. a lumbar disc herniation causing sciatica).
  2. See What You Need to Know About Sciatica

  3. Trial and error. Identifying the problem does not necessarily dictate the solution. There is often more than one way to treat a back condition, and finding the treatment that works best can be a process of trial and error. For example, some people with leg pain caused by a disc problem find that an epidural steroid injection provides great pain relief, while for others it has no effect at all.
Epidural Steroid InjectionsNot all back pain responds to steroid injections.
Epidural Steroid Injections for Back Pain and Leg Pain Video
  1. Individual reactions to treatment. Two people with identical conditions or symptoms may need different treatments. For example, two patients may have a herniated disc that looks identical on an MRI, but one may experience severe pain and disability and find that a microdiscectomy is the surest and quickest path to relief of the leg pain, while the other may find that a customized physical therapy program works best.
  2. See Physical Therapy for Low Back Pain Relief

    See When to See a Surgeon for Low Back Pain

  3. Subjective experience. Pain is a very personal experience. What may be mild back pain to one person can feel severe and incapacitating to another, and for each the level of pain needs to be treated accordingly.
  4. See Pain Management for Chronic Back Pain

With all these factors, along with advances in imaging and treatments, no one doctor can be an expert in all areas of spinal problems.

See Specialists Who Treat Back Pain

This makes it all the more important for you to educate yourself on your symptoms, conditions, and treatment options—the more you know, the better chance you have of finding meaningful and lasting pain relief.

Learn more:

Figuring Out Your Diagnosis

Noninvasive Pain Management Techniques

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