Diagnosing Back Pain

Most GPs (general practitioners, primary care physicians) will be able to diagnose back pain after carrying out a physical examination, and interviewing the patient. In the majority of cases imaging scans are not required. If the doctor and/or patient suspect some injury to the back, tests may be ordered. Also, if the doctor suspects the back pain might be due to an underlying cause, or if the pain persists for too long, further tests may be recommended.

Suspected disc, nerve, tendon, and other problems – X-rays or some other imaging scan, such as a CT (computerized tomography) or MRI (magnetic resonance imaging) scan may be used to get a better view of the state of the soft tissues in the patient’s back.

  • X-rays can show the alignment of the bones and whether the patient has arthritis or broken bones. They are not ideal for detecting problems with muscles, the spinal cord, nerves or disks.
  • MRI or CT scans – these are good for revealing herniated disks or problems with tissue, tendons, nerves, ligaments, blood vessels, muscles and bones.
  • Bone scan – a bone scan may be used for detecting bone tumors or compression fractures caused by brittle bones (osteoporosis). The patient receives an injection of a tracer (a radioactive substance) into a vein. The tracer collects in the bones and helps the doctor detect bone problems with the aid of a special camera.
  • Electromyography or EMG – the electrical impulses produced by nerves in response to muscles is measured. This study can confirm nerve compression which may occur with a herniated disk or spinal stenosis (narrowing of the spinal canal).

The doctor may also order a blood test if infection is suspected.

Chiropractic, Osteopathy and Physical Therapy

  • A Chiropractor – the Chiropractor will diagnose by touching (palpation) and a visual inspection. Chiropractic is known as a direct approach, with a strong focus on the adjustments of the spinal joints. Most good chiropractors will also want to see imaging scan results, as well as blood and urine tests.
  • An Osteopath – the osteopathic approach also diagnoses by touching and a visual inspection. Osteopathy involves slow and rhythmic stretching (mobilization), pressure or indirect techniques and manipulations on joints and muscles.
  • A physical therapist – a physical therapist’s training focuses on diagnosing problems in the joints and soft tissues of the body.

Treatments for back pain

In the vast majority of cases back pain resolves itself without medical help – just with careful attention and home treatment. Pain can usually be addressed with OTC (over-the-counter, no prescription required) painkillers. Resting is helpful, but should not usually last more than a couple of days – too much rest may actually be counterproductive.

Usually back pain is categorized into two types:

  • Acute – back pain comes on suddenly and persists for a maximum of three months.
  • Chronic – the pain gradually develops over a longer period, lasts for over three months, and causes long-term problems.

A considerable percentage of patients with back pain experience both occasional bouts of more intense pain as well as more-or-less continuous mild back pain, making it harder for the doctor to determine whether they have acute or chronic back pain.

Injecting cells to regenerate spine discs – scientists from Duke University, North Carolina, developed new biomaterials that can deliver a booster shot of reparative cells to the nucleus pulposus, effective eliminating pain caused by degenerative disc disease.

If home treatments do not give the desired results, a doctor may recommend the following:

Medication – back pain that does not respond well to OTC painkillers may require a prescription NSAID (nonsteroidal anti-inflammatory drug). Codeine or hydrocodone – narcotics – may also be prescribed for short periods; they require close monitoring by the doctor.

Some tricyclic antidepressants, such as amitriptyline, have been shown to alleviate the symptoms of back pain, regardless of whether or not the patient has depression.

Physical Therapy (UK: physiotherapy) – the application of heat, ice, ultrasound and electrical stimulation, as well as some muscle-release techniques to the back muscles and soft tissues may help alleviate pain. As the pain subsides the physical therapist may introduce some flexibility and strength exercises for the back and abdominal muscles. Techniques on improving posture may also help. The patient will be encouraged to practice the techniques regularly, even after the pain has gone, to prevent back pain recurrence.

Cortisone injections – if the above-mentioned therapies are not effective enough, or if the pain reaches down to the patient’s legs, cortisone may be injected into the epidural space (space around the spinal cord). Cortisone is an anti-inflammatory drug; it helps reduce inflammation around the nerve roots. According to The Mayo Clinic, the pain-relief effect will wear off after less than six weeks.

Injections may also be used to numb areas thought to be causing the pain. Botox (botulism toxin), according to some early studies, are thought to reduce pain by paralyzing sprained muscles in spasm. These injections are effective for about three to four months.

Surgery – surgery for back pain is very rare. If a patient has a herniated disk surgery may be an option, especially if there is persistent pain and nerve compression which can lead to muscle weakness. Examples of surgical procedures include:

  • Fusion – two vertebrae are joined together, with a gone graft inserted between them. The vertebrae are splinted together with metal plates, screws or cages. There is a significantly greater risk for arthritis to subsequently develop in the adjoining vertebrae.
  • Artificial disk – an artificial disk is inserted; it replaces the cushion between two vertebrae.
  • Discectomy (partially removing a disk) – a portion of a disk may be removed if it is irritating or pressing against a nerve.
  • Partially removing a vertebra – a small section of a vertebra may be removed if it is pinching the spinal cord or nerves.

CBT (Cognitive Behavioral Therapy) – according to some studies, CBT can help patients manage chronic back pain. The therapy is based on the principle that the way a person feels is, in part, dependent on the way they think about things. People who can be taught to train themselves to react in a different way to pain may experience less perceived pain. CBT may use relaxation techniques as well as strategies to maintain a positive attitude. Studies have found that patients with CBT tend to become more active and do exercise, resulting in a lower risk of back pain recurrence.

Complementary therapies

A large number of patients opt for complementary therapies, as well as conventional treatments; some opt just for complementary therapies.

According to the National Health Service (NHS), UK, chiropractic, osteopathy, shiatsu and acupuncture may help relieve back pain, as well as encouraging the patient to feel relaxed.

  • An osteopath specializes in treating the skeleton and muscles.
  • A chiropractor treats joint, muscle and bone problems – the main focus being the spine.
  • Shiatsu, also known as finger pressure therapy, is a type of massage where pressure is applied along energy lines in the body. The shiatsu therapist applies pressure with his/her fingers, thumbs and elbows.
  • Acupuncture, which originates from China, consists of inserting fine needles and specific points in the body. Acupuncture can help the body release its natural painkillers – endorphins – as well as stimulating nerve and muscle tissue.

Studies on complementary therapies are have given mixed results. Some people have experienced significant benefit, while others have not. It is important, when considering alternative therapies, to use a well qualified and registered therapist.

TENS (transcutaneous electrical nerve stimulation) – a popular therapy for patients with chronic (long-term) back pain. The TENS machine delivers small electric pulses into the body through electrodes that are place on the skin. Experts believe TENS encourages the body to produce endorphins, and may possibly block pain signals returning to the brain. Studies on TENS have provided mixed results; some revealed no benefits, while others indicated that it could be helpful for some patients.

A TENS machine should be used under the direction of a doctor or health care professional.

Pregnant women, people with epilepsy, people with a pacemaker, and patients with a history of heart disease should not use a TENS machine.

Preventing back pain

Steps to lower the risk of developing back pain consist mainly of addressing some of the risk factors.

Exercise – regular exercise helps build strength as well as keeping your body weight down. Experts say that low-impact aerobic activities are best; activities that do not strain or jerk the back. Before starting any exercise program, talk to a health care professional.

  • Core-strengthening exercises; exercises that work the abdominal and back muscles, help strengthen muscles which protect your back.
  • Flexibility – exercises aimed at improving flexibility in your hips and upper legs may help too.

Smoking – a significantly higher percentage of smokers have back pain incidences compared to non-smokers of the same age, height and weight.

Body weight – the fatter you are the greater your risk of developing back pain. The difference in back pain risk between obese and normal-weight individuals is considerable.

Posture when standing – make sure you have a neutral pelvic position. Stand upright, head facing forward, back straight, and balance your weight evenly on both feet – keep your legs straight.

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