Back Pain Part 5

When Back Pain Strikes:
When back pain strikes the first line of defense is to decide whether it can be treated at home or needs a doctor’s care. Here are some guidelines for when to consult a doctor, what to expect during diagnosis, and when/how to treat back pain at home. When to Consult a Doctor It is important to consult a doctor if you experience any of the following:
• Severe pain that makes it difficult to move.
• Fever and/or vomiting with back pain.
• Loss of bowel or bladder control.
Constipation and frequent or urgent urination are common in some people with low back pain, but any new problems with bowel or bladder should be discussed with a doctor.
• New numbness in the genital or rectal area.
• Pain, numbness, or tingling in another part of the body.
• Leg weakness that is not solely due to pain. Significant leg weakness should be evaluated, especially if you are unable to bend your foot upward, get up out of a chair, or climb stairs.
• Weakness in another part of the body.
• New or increased back pain with unexplained fever, painful urination, or other signs of urinary tract infection (e.g., burning with urination, itching or pain in urethra, lower abdominal discomfort,urge to urinate without passing much urine).
• Dramatic increase in chronic back pain, especially when unrelated to any change in physical activity.
• A history of cancer of HIV infection with the development of new or increased back pain.
• New back pain that does not improve after one week of home treatment.

What to Expect During Diagnosis:

It can be difficult to diagnose back pain, since there can be so many possible causes. For this reason, your family doctor or general practitioner may suggest you see an orthopaedist, rheumatologist, neurosurgeon, neurologist, physical therapist, chiropractor or other medical
specialist for diagnosis (Kemper,University of Washington Department of Orthopaedics 2002).
Regardless of the type of doctor you see, there are some things you can expect in common from any type of doctor.

Medical History:

Most doctors will ask questions about your medical history as well as past and current symptoms. These questions may include the following:
• What are your symptoms?
• Where is the pain?
• Where is the pain most severe?
• When did the pain begin, and how long have you had it?
• Did something specific cause your back pain (e.g. accident or injury)?
• What home treatments have you tried?
• Were you under any additional stress when the pain began?
• What type of work do you do?
• In what types of recreational activities have you participated?
Think through the answers to these questions prior to any doctor’s visit if possible. You may also want to prepare a list of your own questions. As you think of questions you’d like to ask, jot them down and take them to your appointment. After the discussion of your medical history, the doctor will most likely perform a physical examination, including some or all of the following:
• observing your muscles and joints,
• asking you to sit or lie down,
• asking you to move your back in different positions,
• observing and feeling the areas of most pain,
• checking to see if other areas of the body are tender or in pain (e.g., kidneys, intestines, or other organs).

Diagnostic Testing:

Your doctor may need to run some diagnostic tests if more information is needed to help diagnose the problem. These tests may include one or several of the following:
X-ray - X-ray pictures may help determine if pain is due to injury to back
bones, tumor, deformity in spine, or ankylosing spondylitis.
CT or CAT (computerized axial tomography) Scan - A CT scan takes an x-ray that is turned into a 3- dimensional image.
MRI (magnetic resonance imaging) - MRI provides pictures of soft tissues such as muscles, cartilage, ligaments, tendons, and blood vessels, in addition to bone structure.
Myleogram - A myleogram uses a dye injected into the spinal column to detect spinal stenosis, spinal tumors, or other neurological problems. This is often used by neurologists prior to back surgery.
Bone Scan - In a bone scan, a small amount of radioactive liquid is injected into a vein. A radioactive machine scans the area of concern creating a picture to look for damage or tumors in the bones themselves. (Note: Back pain is rarely related to diseases of the bones.)
Electrodiagnostic Studies - There are two types of electrodiagnostic tests; one that uses electrical stimulation to measure the speed of nerve impulses as related to possible nerve compression; the other is a needle test (electromyogram [EMG]) to study the effect of nerve compression on the muscle.
Blood Tests - Blood tests may be ordered, in which a laboratory technician will draw a small amount of blood from your arm. Blood tests may be used to look at a number of things, including a chemical profile, hemoglobin and hematocrit, white blood cell count, etc., which could help the doctor to better determine the cause of your back pain. (Adapted from University of Washington Department of Orthopaedics and Sports Medicine, 2002.)

Doctor recommendations:

In addition to diagnosing back pain, your doctor may recommend ~
• an individualized exercise and home care plan or modified work plan if needed
• prescribed muscle relaxants antiinflammatory drugs, or pain relievers
• physical therapy
• back surgery (Kemper, 1997, pp 99).

Note: Be sure to always inquire what medications are for, how they might affect you, and for how long you will need to use them (University of Washington Department of Orthopaedics and Sports Medicine, 2002). If surgery is recommended, consider all the factors, including second opinions. The most common back surgeries are to remove herniated discs or fuse the lumbar spine. Be sure to discuss the long-term outcome of any surgery with your doctor