Although bouts of back pain and chronic back pain in Bellingham typically go away or go back to its typical level of discomfort, the patient’s medical history as well as a short physical examination is always done by the doctor to help diagnose his condition. The seriousness of the symptoms and how long the symptoms have been present as well as any related medical issues may determine the need for the patient to undergo additional evaluations.
The patient needs to give an account of his back pain as well as its history this way:
- The nature, duration and frequency of the pain
- When the pain happens
- The cause of the pain (like, for example, when a patient lifts a heavy object)
- Factors that worsen the pain (for example, more pain felt when coughing, inhaling, etc)
- Other important symptoms, like numbing of the legs, weakness or morning stiffness
- Past occurrences of back pain
- Past epidural or back procedure
- Seriousness of the pain and the way it hinders the patient’s ability to do regular activities including work activities
- Any situation or thing that relieves the pain
- Any history of accidents or injuries that involve the hips, back or neck
- Other neurological or musculoskeletal issues like osteoporosis or arthritis
The primary aims of a physical exam are to identify where the pain originates, the range of motion of the affected parts of the body and to look for signs of more severe types of back problem.
During the exam:
- Patients are told to walk (on their heels, on their toes or flat-footed among others), stand and sit.
- Patients will be required to bend sideways and to twist and also bend backward and forward.
- Patients will be told to lift their leg straight up while lying down. The doctor or physical therapist will shift the patient’s legs in different positions and straighten and bend the knees. Sciatica pain will be increased when the affected leg is lifted straight in the air. The pain is characterized by tingling or numbness and is localized and sharp.
Reflex and Nerve Function Test
This test is done by tapping the ankles and knees of the patient with a rubber hammer by the health specialist. The specialist can also lightly touch the affected areas with a feather, cotton swab or pin to determine nerve sensitivity and numbness.
For imaging tests a MRI, CT scan or x-ray can be used to assess the scope of the back pain. To scan for osteoporosis a DEXA or dual energy X-ray absorptiometry can be used while for infection, cancer or arthritis a nuclear scan can be performed.
Imaging tests and other sophisticated diagnostic tests are often performed on patients who experience certain events or exhibit the following symptoms:
- Significant pain lasting a month or two
- Tingling, numbness, pain or any other symptoms ranging from the buttocks to the leg that are getting worse or extremely serious
- Weakness in the muscle that seems to be worsening, persistent and significant
- Past injury or accident that may have injured the vertebrae or discs
- A history of cancer
- Signs of an underlying condition like unexplained weight loss or fever
- New pain manifesting in patients 65 years old and older
MRI – An MRI or magnetic resonance imaging device can produce high resolution images of bone and soft tissue. This is a painless and harmless test that can identify disc fragments, disc herniation and tears in the disc. It can also identify spinal stenosis as well as non-spinal factors causing back pain like cancer and infection.
CT scan – Computerized tomography scan or CT scan utilizes a narrow x-ray beam that is rotated around the part of the body to be studied. CT scans can produce very clear and 3-D images of a body part.
X-rays – Simple and acute low back pain sufferers are usually given x-ray tests to help their doctors analyze their spinal column. X-ray tests are not really important if a patient suffers from a nonspecific back pain.
Other Diagnostic Tests for Back Pain
SPECT Imaging and Bone Scintigraphy – Bone Scintigraphy is rarely used. When utilized, it scans for bone abnormalities and it can be helpful in detecting specific arthritic conditions, cancer of the bone and in the early identification of spinal fractures. This test entails injecting the patient with a tiny dose of radioactive material into his vein. The material circulates through the body where it is monitored by a device called SPECT or single photon emission computed tomography. Later on, the radioactive material is absorbed by the patient’s bones
Electrodiagnostic tests – These are tests that study the muscle’s and nerve’s electric waveforms that can help identify nerve or muscle abnormalities likely generating the back pain as well help detect possible injuries. They can also tell the doctor whether any abnormal structural findings on imaging tests such as MRI and other tests are the real cause of the back pain. The most common types of electrodiagnostic test are the electromyography and nerve conduction tests. They are usually done to help evaluate and manage patients with low back pain.
Discography – This test lets the doctor know if the abnormal disc structure seen in the MRI is causing the patient’s back pain. This test is used for patients who have not found pain relief from conventional treatments including back surgery. It is a painful and invasive procedure that entails injections into discs believed to be where the pain originates. Because of its highly invasive nature, doctors rarely use this technique.
Blood and urine tests – Samples of the patient’s urine and blood can be tested to identify signs of arthritis, infections or other conditions.
Another type of back pain test is to inject into the nerves in the back medication that blocks out pain. This will help the doctor find out the exact location where the spine problems come from.