Getting an accurate neck or back pain diagnosis is not always a straightforward process. Some common sources of frustration may include:
- Diagnostic tests providing limited information
- Subpar diagnostic testing method and/or technique
- The underlying cause of the patient’s pain is not clearly isolated and defined
- Doctors disagreeing about a diagnosis or treatment plan
- Cases where a diagnosis cannot be reached
These special considerations for a neck or back pain diagnosis are discussed below.
When Diagnostic Tests Do Not Provide a Diagnosis
No single diagnostic test can, by itself, diagnose the underlying condition that is causing neck or back pain. An accurate clinical diagnosis for spinal pain is based on correlating the patient’s symptoms with the doctor’s findings from the physical exam and medical history. These findings must also relate to the diagnostic findings from imaging, electrodiagnostic testing, and diagnostic injections, and the response to treatments, such as physical therapy, medications, ergonomic modification, and activity modification.
For example, while an MRI may confirm a disc herniation at a specific level of the spine, the MRI image alone cannot prove that this herniated disc is causing pain. If the location of the herniated disc correlates with the patient’s described symptoms and other clinical findings, a diagnosis of the herniated disc causing pain may then be highly suspected.
It is important to focus on the clinical diagnosis rather than what one specific diagnostic test shows. An MRI or other imaging test commonly shows some degeneration or other issues in the spine that do not cause pain or other symptoms. For this reason, the path to an accurate diagnosis must follow what makes sense in the context of the patient’s symptoms, not what is seen on the scan.
Controversies in Diagnostic Testing for Neck or Back Pain
Frequently, no diagnostic testing or specific diagnosis is needed to provide or start appropriate treatment. Diagnostic tests tend to be expensive and are only useful in specific cases, so they are only performed when there is reason to believe that they will be helpful. Even so, doctors may not always agree on the right time to order diagnostic tests or even which tests are most useful.
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One of the more controversial diagnostic tests for neck or back pain is a discogram, which is an injection technique used to determine if a specific disc is generating pain. There is disagreement within the medical community regarding the usefulness of a discogram, and there is some evidence to suggest that the injection directly into the disc could cause a new herniation to occur or enlarge an existing one, and/or accelerate degeneration over time. While discograms are not commonly performed anymore, they are more likely to be used for the lumbar spine rather than the cervical spine.
When No Anatomical Reason for Spine Pain Can Be Found
Despite the best technology and diagnostic tests available today, there are still cases when no anatomical reason can be found for neck or back pain. Even if the doctor cannot identify the cause of the pain, the pain needs to be managed.
Pain management specialists focus on providing diagnosis, treatment, and techniques for people with chronic pain that cannot 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 neck or back pain.