Back pain diagnosis is quite complex as there can be multiple reasons causing back pain. The spine itself is a complex structure with soft tissues supporting it for smooth functioning of the movement the spine. Any disturbance to the spine itself or to the supporting structures can result in back pain.
Even a damage or disturbance to the organs near the spine can cause pain in the back. Hence, getting an accurate diagnosis is relatively difficult than for other medical conditions.
Although some of the diagnoses may be clear-cut such as tumors, infections, or fractures, for many, arriving at a diagnosis may be a real challenge.
In spite of the challenges in diagnosing the causes for back pain, it is very essential to arrive at an accurate diagnosis for providing appropriate treatment in order to obtain pain relief for the patient.
The patient will be asked various questions to determine the history of back pain. This would include asking the patient to explain about the pain such as the location of the pain, if there is any radiation of pain, what sort of activities he is able to perform, if any position is causing pain, etc. Ayurveda gives a lot of emphasis on certain additional aspects of health, like bowel movements, state of digestion, balance of the Doshas (Vata, pitta and Kapha) and state of the mind as vital aspects in understanding the cause of back pain as well.
The review of the medical history will then be followed by a detailed physical examination performed by the physician. This will consist of testing the patient’s reflexes, the functioning of the nerves to determine for any sensory deficits, checking the range of motion, determining if there is any loss of strength in the arms and legs and also if there is any pain with certain positions. The physician will have a fair idea of the diagnosis once the physician examination is completed.
It is most likely that the physician might have arrived at the appropriate diagnosis during the physical examination itself, but the physician might also recommend various diagnostic tests to confirm his diagnosis. Some of the diagnostic tests include,
In case the physician suspects problems with bone structures such as fracture or tumor, the patient might be recommended an x-ray. X-rays are less expensive and generally obtained first. Once the physician gets a fair idea of the diagnosis, more advanced imaging studies might be recommended.
Although x-rays show the bone structures, it might not be the appropriate study if the physician wants to check for any minute details in the bone itself. So, if the physician suspects something in the lines of a herniated disc or stenosis of the spine, he might recommend a CT scan.
When the condition warrants checking the discs of the spine or the nerves completely, MRI is very helpful. MRIs are also useful to rule out tumors, disc herniation, or spinal infections. It is one diagnostic test that will help in ruling out most of the reasons for the back pain.
In case the physician wants to assess the electrical activity of a nerve root, he might recommend an EMG. This test is useful in case of neuropathy or radiculopathy.
To rule out an inflammatory process, such as an infection, a bone scan might be recommended.
It is usually recommended to assess for the risk of fracture by identifying osteoporosis of the vertebrae.
Although there are multiple advanced diagnostic tests to diagnose the cause of the back pain, one must remember that not all pain is explained with the diagnostic studies.
There are several patients who might have very minor problems in the radiological studies but who complain of very severe pain and others who have very severe problems in the radiological studies but who are clinically normal. Some of the pain may be totally unexplained by the diagnostics tests as well.
These are due to the overlay of individual constitutional aspects, pain threshold of the person, functional aspects of a person, like, the imbalance of the Doshas (vata, pitta and kapha) and the state of mind. Also it is possible that despite all the detailed diagnostic tests, one may not be able to find an anatomical reason for the patient’s pain.
So, the most practical approach would be for a clinician to assess the patient completely using Ayurvedic and modern clinical examination and based on the clinical diagnosis, to use additional tests if needed, to understand the exact causes of back problems to institute appropriate treatment.