Getting relief for chronic back pain – estimated to affect 80% of American adults at some point in their lives – isn’t as easy as showing up at a doctor’s office and saying your back hurts. In fact, patients should be prepared to answer as many questions as they ask in order to receive an accurate diagnosis, according to Kaliq Chang, MD, of Atlantic Spine Center.
“Back conditions can be complex, so patients would benefit from being aware of the details of their symptoms and be ready to communicate them to practitioners,” says Dr. Chang, an interventional pain management specialist. “Low back pain isn’t a specific diagnosis in itself, and receiving an accurate diagnosis is absolutely crucial to addressing the problem correctly. Indeed, we’re hard-pressed to fix a patient’s back problem if we can’t pinpoint what’s causing it.”
Initially, a variety of non-invasive measures – including medication and physical therapy – are used to treat lingering back pain that stems from injuries, aging, genetics or any other cause. Interventions such as steroid injections, nerve ablation procedures, and spinal cord stimulators are employed when those modalities do not provide adequate relief. Finally, surgery is considered a last resort only after these less invasive treatments have failed.
Fruitful Q&A between doctors and patients
When patients come to Dr. Chang complaining of back pain, his first step is to obtain a complete history of symptoms. Here are some of the most important questions he says patients should be prepared to answer to receive a precise diagnosis:
- Where is your pain? Neck, mid-back or lower back?
- When did your pain begin? Was it related to an activity or injury?
- Have you had a prior episode of back pain?
- How would you describe your pain? Stabbing, sharp, burning, aching, cramping, throbbing or otherwise?
- Does your pain radiate into your legs? From your buttocks into the upper leg? Past the knee to the ankles or feet? Down one leg or both?
- Does your pain get worse after activity?
- What triggers your pain? Sitting, standing, walking, laying down, bending forward, bending backward?
- What improves your pain? Sitting, standing, walking, laying down, bending forward, bending backward?
- What pain treatments have you already undergone? Chiropractic treatment, physical therapy, acupuncture, spinal injections? Surgeries such as open spine decompression or spinal fusion?
- Do you have any other health problems?
- What medications do you take?
Testing can help pinpoint a diagnosis
After a detailed question-and-answer session between patients and doctors and a physical exam, certain diagnostic tests may be ordered to shed further light on the problem. These tests, which include electromyography (EMG) and nerve conduction studies, x-rays or MRI images, are used to confirm any abnormality or disease in the spine that may cause pain, such as bulging or herniated discs, spinal stenosis or other back conditions.
“Tests can’t determine what’s actually causing a patient’s back pain,” he says. “That’s why it’s so important that patients provide detailed information about the history and course of their symptoms to their doctor. Tests can only enhance what the patient is able to convey about their situation.”
Dr. Chang encourages people to be patient when attempting to figure out exactly why their back hurts, as difficult as that may seem at the time.
“A lot of back pain can be short-lived,” Dr. Chang says. “Different diagnoses will require very different treatment approaches, so accurately diagnosing back pain is critical. The sooner a precise diagnosis is made, the sooner patients can access the right treatment to achieve pain relief and boost their enjoyment of everyday activities.”
Kaliq Chang, MD, is an interventional pain management specialist board-certified in anesthesiology at Atlantic Spine Center.