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Methods of Back Pain Diagnosis
Methods of Back Pain Diagnosis
By Brennan Howe
In order to diagnose for relief treatments, generally
health care professional begin by ordering a medical history and
physical examination. A look at each of these in depth can
shed some light into what to look for and how to find relief from
pain. Then we’ll look at specific diagnostic tests. And
then where to go for the diagnosis and testing follows.
No matter whether the patient has acute back pain, which is what
most have and recover from with around a 4-week period, or chronic,
recurring pain episodes, a medical history helps patient an doctor
become familiar with one another in confidence to begin or continue
a treatment program together. The medical history delves into
these areas of the person seeking pain relief: family medical
history and personal and work history with regards to
episodes and related symptoms and issues, psychological and
psychosocial factors, referral source(s) for evaluation and
treatment, education on the subject and treatment options,
assessment throughout their working together on pain relief
treatment and treatment outcomes. For example, if physical
therapy needs to be added to the regimen or enhanced, it would be
discussed in the medical history and updated as needed.
The medical history incorporates past and present factors of
fatigue, fever and weight loss. And it notes any use of drugs
or herbs, minerals and supplements. A history of past and
present infections, cancer or other conditions is also noted.
The history also includes details about the back pain, focusing on
the many facets of the pain: information about any initial injury or
trauma, if available, onset, intensity, duration, location,
associated symptoms, etc.
The physical examination includes evaluating the person generally
inn the “hospital gown” with the body and especially the back in a
variety of postures and movement ranges to determine pain symptoms,
tenderness and range of motion. So the patient may need to
sit, stand, touch toes, move arms, etc. and share any pain symptoms
or other information notated with each change along the way.
Neurological testing can also be a part of the routine. A
neurological screening may consist of tests for reflexes, strength
of muscles, cramping and a detailed look at sensory issues via
various range of motion and movement exercises. Included in
this can be an assessment of the legs, upper leg, hip and groin area
and pulses for neurological and vascular conditions.
Results may point to a secondary problem like kidney stones or a
slight bone fracture, for instance, in which cases, further
assessment and treatment options would be considered and discussed
in both the medical history and physical examination.
Noteworthy is that patients seeking relief after an extended period
can tend to exaggerate or magnify their symptoms out of a variety of
reasons; possibly psychological factors associated with fear of the
unknown, change, coping alternatives, insurance coverage and
treatment costs, previous visits with health care providers, etc.
So education and patience is advised to that all bases can be
covered, i.e. so that effective pain relief remedies can be
determined.
For relief, any of several tests can be performed; x-rays
or radiographs, isotope bone scan (referred to as technetium and
SPECT), magnetic resonance imaging (MRI), computerized axial
tomography (CAT) scan, myelogram, blood and nerve tests and
injections.
Where To Go For Pain Relief
Where to go for a diagnosis about can include your family
doctor, the emergency room, an orthopedic surgeon, a naturopathic
specialist, a rheumatologist , an occupational therapist, a
physiotherapist, a chiropractor, an acupuncturist, a massage
therapist, an osteopath and a chronic pain heath care provider.
And here is a brief overview of each.
FAMILY DOCTOR – This is a popular beginning point for many seeking
back pain relief. Although family doctors generally do not
have extensive orthopedic backgrounds nor sufficient time to
schedule complete histories and examinations during regular hectic
weekdays, they are often able to do preliminary testing and
assessment. Their blood tests and general knowledge of your
health and basic back care can help them point you to further
resources and places for following up, especially if they deem the
case an emergency. And hopefully your family doctor will be at
the center or helm of your pain relief management so that all
testing, treatments, office visits, etc. are coordinated and not
left to chance, and also so that patient care is optimized.
EMERGENCY ROOM – When a family or general doctor is not available,
some symptoms may warrant an emergency room visit. The
following list of symptoms, though not limited, is what most often
sends people to the emergency room for relief; a major
injury or trauma, history of osteoporosis, steroid medications or
cancer, severe pain, fever, aggressive or quick weight loss for no
known reason. The degree of suggested seriousness in the
symptoms may determine how quickly a person is seen in the emergency
room, with the more serious cases seen quicker.
Emergency room procedures can involve history and examination
assessments and a series of blood, urine and other tests.
Additionally the emergency room physician may recommend a consult
with a specialist while you are there. Or they may recommend
you to your family doctor or other treatment facility for follow up,
depending upon their results.
ORTHOPEDIC SURGEON – Orthopedic medicine in a nutshell deals with
the prevention or correction of injuries or disorders of the
skeletal system and associated muscles, joints, tendons and
ligaments. Surgeons in this field offer treatment for fractures,
strains, arthritis, dislocations and other related problems
throughout the entire body. And their treatments vary with
surgery and non-surgical health care; structure repair, joint
replacement, arthroscopy or the examination and possible
treatment
of the interior of a joint, like the knee, using a type of endoscope
inserted into the joint through a small incision. Likewise,
they coordinate healing activities during healing and pain relief
stages. Note that some orthopedic surgeons specialize: in the
area of relief, a specialist based in spinal practice may
be advisable.
NATUROPATHIC SPECIALIST – Naturopathic medicine refers to natural
substances or remedies massage as treatments. Doctors in this
field are educated in nutrition and herbal, botanical, homeopathic
and Chinese medicines (and acupuncture). They may also treat
with hands-on procedures and lifestyle consultations where
preventative measures are a focus. These specialists may refer
you to your family doctor and may also coordinate healthcare
activities before, during and after your episode for
overall improved wellness. Often for relief, they
may advise natural supplements like herbal medicines or minerals
along with dietary modifications. And physical therapy;
acupuncture or message, combined with stress management and
relaxation therapy may be added in for good measure.
RHEUMATOLOGIST – A rheumatologist deals with an array of
pathological conditions like arthritis related to the tendons,
muscles, joints, nerves or bones, when seeking aid for discomfort
and disability. Although some may perform arthroscopy, most do
not do surgery. For relief, they may suggest
medications, occupational or injection therapy and other medical
treatment to determine cause and pain relief.
OCCUPATIONAL THERAPIST – An occupational therapist emphasizes
correct ergonomics or design factors, posture and safety practices
both at the workplace and in the home environment. These
therapists educate patients about daily life activities and can help
with adjusting to health devices for mobility and operation.
Adjusting to using crutches, a back brace, a cane and other
lifestyle changes are benefits of occupational therapy.
PHYSIOTHERAPIST – Registered therapists practice physiotherapy and
focus on educating and instructing patients about their pain- both
in book learning and physical understanding, like with posture and
movement modifications. Their shared knowledge helps patients
overcome fear and anxiety and better manage their treatment
programs. Doctors often refer patients to physiotherapists for
extended learning, particularly if there is difficulty in diagnosing
the cause and / or treatment for pain. Additionally,
physiotherapists help with the development and managing of their
healthcare programs, activities and preventive care instruction. For
example, they may teach about using heat or ice along with a varied
range of motion for pain relief.
CHIROPRACTOR – In a nutshell, chiropractors diagnose spine, joint
and muscle problems with their hands. And their treatment is
hands-on as well. For relief, they use mobilizations
and manipulations in manual spinal movements, some known as
“cracking” the back into place. Although there is no
scientific evidence to support or negate chiropractors treatment,
most generally work with the relief of acute low back pain.
Besides in-office treatment, many provide exercise and preventative
strategies for follow up.
ACUPUNCTURIST – Acupuncture, relating to Chinese medical practice,
is the piercing of specific areas of the body with fine needles.
The reasons for acupuncture are threefold; for therapeutic purposes,
to relieve pain or for regional anesthesia. It is mainly used
for musculoskeletal pain and low and other related relief.
MASSAGE THERAPIST – Massage therapy incorporates hands-on handling
or manipulation of body tissues, especially helpful for low back
pain relief. The reasons for massage vary; for relief from
pain and muscle spasms associated with it, for relaxation, for
stretching, improved circulation and metabolism.
OSTEOPATH – Osteopaths use Osteopathic Manual Medicine (OMM) to
practice medicine based on the theory that conditions in the
musculoskeletal system affect other bodily parts. These
conditions cause disorders that they believe can hopefully be
corrected by manipulative techniques combined with traditional
medical, pharmacological, surgical and other therapeutic strategies.
Generally within 10 to 14 days, osteopathy relieves low back pain.
But there is no evidence to suggest osteopathy as preventative
treatment long-term.
CHRONIC PAIN SPECIALIST – A chronic pain specialist is for rare
cases and works in teams. He or she generally manages pain
relief treatment with psychiatrists, social workers and other
medical and counseling healthcare providers.
The main relief treatment for chronic low is conservative
intervention. In other words, jumping into surgery is not
advised because many people suffer no yet have
degenerative change or aging issues going on in the back region.
And other treatment options may offer relief instead. And according
to studies, there is no evidence that points to delayed surgery
resulting in increased complications. In fact approximately 80
percent of the cases where surgery was indicated as a solution
recovered regardless of the surgery. So whether or not they
had it made no difference. Really under 40 percent are
reported to have benefited from surgery. And on the contrary, those
people with surgical pasts reported the need for future surgeries,
many because their pain actually increased with surgery. So
good medical history and physical examination preparation and
assessment can go a long way in determining treatment options.
Conservative treatment would include an overall physical and
psychological pain-handling program incorporated into the patient’s
lifestyle. It would education and offer training about symptom
management; movement and posture strategies, physical therapy,
acupuncture, epidural analgesics, pain medication and other
associated issues.
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