Getting an Accurate Back Pain Diagnosis - Newsletter

Dear Spine-Health Member,

Getting an accurate diagnosis for your back pain is critical, because different diagnoses will require very different treatment approaches. And the sooner you get an accurate diagnosis, the sooner you can start on a road to back pain relief.

Because the causes of back pain can be very complex, it is often more difficult to get an accurate diagnosis for back pain than for other medical conditions. While some diagnoses are relatively straightforward (such as tumors, infections, fractures), for many conditions there is little agreement among spine specialists about a diagnosis.

This newsletter provides you with some information designed to help you navigate through the process of getting a back pain diagnosis.

Terminology Is Confusing and May Be Misleading

There are many terms to describe spinal disorders, and different healthcare practitioners use many terms differently. For example, the same spinal disc abnormality might be termed a herniated disc, pinched nerve, bulging disc, protruding disc, slipped disc, or prolapsed disc. There is no agreement in the medical field as to the precise definition of any of these terms.

Often the patient hears his or her diagnosis referred to in different terms by different practitioners and wonders what the real diagnosis is.

Additionally, conventional medical terminology can sometimes be misleading. For example, failed back surgery syndrome is not really a syndrome, but rather a situation in which the patient experiences continued pain after surgery that can be caused by many different factors. Likewise, degenerative disc disease is not really a disease, but rather a degenerative condition that at times can produce pain from a damaged disc. While everyone's discs degenerate as they age, not everyone will develop painful symptoms. For more information, see the following article:

• What's a herniated disc, pinched nerve, bulging disc?

Focus on the Clinical Diagnosis

Rather than focus on the terminology referring to spinal anatomy, it’s most helpful for patients to focus on understanding the clinical diagnosis. It should be kept in mind that many medical terms (such as herniated disc) refer to radiographic findings seen on a CT scan or MRI scan. However, an accurate clinical diagnosis is based on the combination of findings on the diagnostic tests (such as an MRI), your specific back pain symptoms, and the physician's findings on a complete physical exam.

Diagnostic Studies Are Used to Confirm an Injury

Diagnostic studies are used to confirm an anatomical lesion (injury) as a cause of back pain, neck pain or sciatica. They are particularly useful to pinpoint the source and extent of the injury, which in turn assists in the diagnosis and development of an appropriate treatment plan. The most common diagnostic tests include:

• X-rays, which provide detail of the bone structures in the spine, and are used to check for instability (such as spondylolisthesis), tumors and fractures.
• CT scans, which are essentially a fancy x-ray that takes cross-section images of the body. They provide excellent bony detail and are also capable of imaging for specific conditions, such as a herniated disc or spinal stenosis.
• MRI scans, which are particularly useful to assess certain conditions by providing detail of the disc (such as for degenerative disc disease, isthmic spondylolisthesis) and nerve roots (such as for herniated discs, spinal stenosis). MRI scans are also useful to rule out tumors or spinal infections. Before an MRI scan is performed, the physician usually has a good idea of what he or she is looking for, and the scans are most commonly used for pre-surgical planning, such as for a microdiscectomy or spinal fusion.

There are a number of other imaging and electrical studies that may also be used, and some injections are used for diagnostic purposes as well as for pain relief. For more information, see the following articles:

• Overview of diagnostic studies
• Do I need an MRI scan?

Some Diagnostic Tests Are Controversial

There is very little that all physicians agree on when it comes to diagnosing and treating back pain. For example, a discogram, which is an injection technique to determine if a disc is generating pain, is quite controversial. Some surgeons believe that a discogram is the only way to determine if the disc is painful, and some believe that the test is not useful. As with most controversies, the truth is some where in between, and it probably is a useful test when done by an experienced discographer and for the right reasons. As with all other tests, the results of the discogram need to be carefully correlated with other tests and the patient's symptoms. For a complete review of this controversial procedure, see the following article:

• Lumbar discography for back pain diagnosis.

There are other tests that are also controversial and are used variably by different practitioners. These include EMG's (electromyography), selective nerve root blocks, and facet blocks. While there is not complete agreement about when the tests should be done, the important thing is that the results need to be correlated with the patient’s symptoms and other tests. For a review of injections used for diagnostic purposes, see the following article:

• Injections.

An Interdisciplinary Approach Can Sometimes Help

There are far too many causes of back and neck pain for any one type of medical practice or practitioner to have all the answers. And with advancements in technology and medical techniques, the complexity in diagnosing back pain keeps increasing. Because of this, more spine specialists are getting together in integrated spine clinics to diagnose and treat patients with back pain or neck pain. Ideally, an integrated spine care clinic can diagnose back pain with better coordination of care, appropriate referrals between specialists, and greater resources to keep up with medical advancements. Having all the specialists in one clinic should also be more convenient for the patient. For more information, see the following articles:

• Specialists who treat back pain
• The integrated approach to back pain treatment.

To find a spine specialist, please use our Spine Directory – Spine-health.com’s online directory of spine specialists.

When No Anatomical Reason for the Pain Can Be Found

Hard as it is to believe, despite a battery of diagnostic tests many times there is no anatomical reason that can be found that can account for a patient's back pain. However, if there is no anatomical reason for your pain, the pain is still real and needs to be managed. Pain specialists focus on providing diagnosis, treatment, and techniques for people with chronic pain that can't be addressed through surgery. Many integrated pain clinics also provide support resources, such as a support group and counseling, as well as medical treatments to manage your back pain.

Despite all the advances in medical care for back pain, there is still a lot that science does not yet understand. In particular, the causes of back pain can be very complex, making it difficult at times to get an accurate diagnosis. Ideally, taking a proactive approach in the process of getting a diagnosis can help you get on the road to recovery sooner and with fewer detours.

Best regards,
Peter F. Ullrich, Jr., M.D., Medical Director
Stephanie Burke, President
Spine-health.com

About the Spine-health.com Newsletter: Each issue of the Spine-health.com newsletter, SpineNews Update, is written by the founders of Spine-health.com - Peter F. Ullrich, Jr., M.D., Medical Director for Spine-health.com and Stephanie Burke, President of Spine-health.com. The content in the newsletters is not peer reviewed by Spine-health.com’s Medical Advisory Board. The articles to which the Spine-health.com newsletters link have been peer reviewed by members of the Medical Advisory Board.