Main Considerations When Getting a Back Pain Diagnosis

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 patients get on the road to recovery sooner and with fewer detours.

Terminology Problems

Many terms are used to describe spinal disorders, and healthcare practitioners often use terms differently. For example, the same spinal disc abnormality might be described as 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 various health professionals and wonders what the real diagnosis is.

Additionally, conventional medical terminology can sometimes be misleading for back pain sufferers. As an example, 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.

Diagnostic Tests Do Not Provide a Diagnosis

Rather than focus on the MRI or other test terminology referring to spinal anatomy, it’s most helpful for patients to focus on understanding the clinical diagnosis for their back problems. 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, but the tests cannot determine what is actually causing the patient’s back pain.

An accurate clinical diagnosis for the patient’s back pain is based on correlating the findings of the diagnostic tests (such as an MRI), with the patient’s specific symptoms and the physician’s findings from a complete physical exam.

Diagnostic tests are used to confirm an anatomical lesion (meaning any abnormality or disease) as a cause of pain. They are particularly useful to pinpoint the source and extent of the lesion (such as a herniated disc, degenerated disc, or the degree of spondylolisthesis), which in turn assists in the diagnosis and development of an appropriate treatment plan.

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Some Diagnostic Tests for Back Problems Are Controversial

There is little that all physicians agree on when it comes to diagnosing and treating back pain. For example, a discogram, which is an injection technique used to determine if a specific disc is generating pain, is quite controversial. If used, the results of the discogram need to be carefully correlated with other tests and the patient's symptoms.

There are other tests that are also controversial and are used variably by different practitioners. These include EMGs (electromyography), selective nerve root blocks, and facet blocks. While there is not complete agreement about when the tests should be done in the process of diagnosing the cause of pain, it is always important that the test results need to be correlated with the patient’s symptoms and other tests.

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When No Anatomical Reason for the Back Pain Can Be Found

While it is difficult 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 pain. However, even if the doctor cannot identify the causes of the patient’s pain, the pain is still real and needs to be managed.

Pain medicine 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 the back pain.

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