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Back Pain – Diagnosing the Cause of Your Low Back Pain
A thorough medical history and physical examination can usually identify any risk conditions or family history associated with back pain.
During the exam, your doctor will ask you to describe the location of pain onset, and intensity; duration of symptoms and any limitation in movement; and your history of past episodes or any health conditions associated with your pain. The doctor will examine your back and perform neurological tests to determine the cause of the pain and appropriate treatment. Blood tests and/or imaging tests may be ordered to help diagnose tumors or other possible sources of pain.
The following diagnostic methods are used to confirm the cause of back pain:
- X-ray imaging. X-ray imaging includes both traditional and modified methods to help diagnose the cause and location of back pain. Conventional X-rays detect broken bones or injured vertebrae, but tissue masses such as injured muscles and ligaments or painful conditions such as bulging discs are not visible on conventional X-rays. X-ray imaging is a quick, non-invasive, painless procedure performed in a doctor’s office or clinic.
- Discography. Discography involves the injection of a special contrast dye into the spinal disc that causes back pain. X-rays taken after dye injection show damaged areas. Discography is recommended for patients who are considering lumbar surgery or whose pain is unresponsive to conventional treatment.
- Computed Tomography (CT). This is a quick and painless procedure when a herniated disc, spinal stenosis or vertebral damage is suspected as the cause of back pain. X-rays pass through the body at various angles and are detected by a computerized scanner to create two-dimensional slices of the internal structures of the back. Computed tomography is a diagnostic test that is usually performed at an imaging center or hospital.
- Magnetic resonance imaging (MRI). MRI is used to evaluate the lumbar region for bone loss or injury or disease in the tissues and nerves, muscles, ligaments, and blood vessels. Scanning devices create a magnetic field around the body that can temporarily restore water molecules in tissues. Then, the radio waves pass through the body to find the “rest” of the molecules and return in random alignment, triggering resonance signals at different angles in the body. A computer processes these resonances into a three-dimensional picture or two-dimensional “slice” of the scanned tissue. It differentiates between bone, soft tissue, and fluid-filled spaces by water content and structural properties. MRI is a non-invasive procedure that is often used to identify conditions that require immediate surgical treatment.
- Electrodiagnostic procedures. Electrodiagnostic procedures include electromyography (EMG), nerve conduction studies, and evoked potential (EP) studies. An EMG evaluates the electrical activity in the nerve to detect muscle weakness due to an injury or problems with the nerves that control the muscles. With EMG, very fine needles are inserted into the muscles to measure the electrical activity transmitted from the brain or spinal cord to specific areas of the body. Nerve conduction studies involve two sets of electrodes placed on the skin over the muscles. The first set of electrodes gives the patient a gentle shock to stimulate the nerve that runs to a specific muscle. Another set of electrodes records electrical signals from the nerves. From this information, doctors can determine if there is nerve damage. EP tests also involve two sets of electrodes—one set on the scalp to stimulate sensory nerves and the other to record the speed of nerve signal transmission to the brain.
- Bone scan. Bone scans are used to diagnose and monitor infections, fractures, or disorders in the bones. A small amount of radioactive material is injected into the bloodstream to collect in the bone, especially in areas with some abnormalities. Scanner-generated images are sent to a computer to identify areas of irregular bone metabolism or abnormal blood flow and measure the level of joint disease.
- thermography. Thermography measures small temperature changes in the temperature of two sides of the body or a specific organ using infrared sensing equipment. It can be used to detect the presence or absence of nerve root compression.
- Ultrasound imaging. Also called ultrasound scanning or sonography, ultrasound imaging uses high-frequency sound waves to obtain images of the inside of the body. Sound wave echoes are recorded and displayed as real-time visual images. Ultrasound imaging can show tears in the ligaments, muscles, tendons, and other soft tissues of the back.
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