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Diagnosing Back Pain

A thorough medical history and physical exam can usually identify any dangerous conditions or family history that may be associated with the back pain. The patient describes the onset, site, and severity of the pain; duration of symptoms and any limitation in movement; and history of previous episodes or any health conditions that might be related to the pain. The physician will examine the back and conduct neurologic tests to determine the cause of pain and appropriate treatment.

A variety of diagnostic methods are available to confirm the cause of low back pain.

X-ray imaging includes conventional and enhanced methods that can help diagnose the cause and site of back pain. A conventional x-ray, often the first imaging technique used, looks for broken bones or an injured vertebra. Tissue masses such as injured muscles and ligaments or painful conditions such as a bulging disc are not visible on conventional x-rays.

Discography involves the injection of a special contract dye into a spinal disc thought to be causing the low back pain. The dye outlines the damaged areas on x-rays taken following the injection. This procedure is often suggested for patients considering lumbar surgery or whose pain has not responded to conventional treatments.

Computerized tomography (CT) is a quick and painless process used when disc rupture, spinal stenosis, or damage to vertebrae is suspected as a cause of low back pain. X-rays are passed through the body at various angles and are detected by a computerized scanner to produce two-dimensional slices of internal structures of the back. 

Magnetic resonance imaging (MRI) is used to evaluate the lumbar region for bone degeneration or injury or disease in tissues and nerves, muscles, ligaments, and blood vessels.

Electro diagnostic procedures include electromyography (EMG), nerve conduction studies, and evoked potential studies. EMG assesses the electrical activity in a nerve and can detect if muscle weakness results from injury or a problem with the nerves that control muscles.

Bone scans are used to diagnose and monitor infection, fracture, or disorders in the bone. A small amount of radioactive material is injected into the bloodstream and will collect in the bones, particularly in areas with some abnormality. Scanner-generated images are sent to a computer to identify specific areas of irregular bone metabolism or abnormal blood flow, as well as to measure levels of joint disease.

Thermography involves the use of infrared sensing devices to measure small temperature changes between the two sides of the body or the temperature of a specific organ. Thermogrphy may be used to detect the presence or absence of nerve root compression.

Ultrasound imaging, also called ultrasound scanning or sonography, uses high-frequency sound waves to obtain images inside the body. Ultrasound images can show tears in ligaments, muscles, tendons, and other soft tissue masses in the back.