How to Deal with Unknown Causes of Back Pain?

Back pain is one of the most common complaints treated by physicians. Nearly 4 out of 5 people will experience back pain at some time in their life. The vast majority of these cases do not have a definable cause for their pain. This is an important, common problem and the annual cost of treating this pain runs in the tens of billions of dollars.

Causes

Back pain can develop in association with a number of causes such as

• muscle strain
• injury to the back,
• overuse
• muscle disorders
• pressure on a nerve root
• poor posture

Pregnant women, smokers, construction workers, and people who perform repetitive lifting all have increased risk of back pain.

When the cause is unknown

For about four out of five people walking into their doctors' offices with low back pain, the cause is unknown. That is, four times out of five the cause of low back pain is deemed "nonspecific." The doctor isn't able to identify a cause of back pain based on:

• What the person tells him or her
• A physical examination

In most cases of back pain, if you have no history of prior cancer or systemic disease and no apparent nerve problems, your doctor may not recommend diagnostic tests. Instead he or she may suggest an initial conservative approach to treatment. That's because the reason for your back pain is likely some sort of nonspecific musculoskeletal cause that may respond well to conservative treatment.

Diagnosis

To rule out other causes of back pain, or to confirm a possible cause, your doctor may recommend one or more diagnostic tests. They may include:

• X-rays X-rays can reveal bone problems, tumors or degenerative changes (wear and tear, or aging) in your spine.
• Computerized tomography (CT) Using computers and X-rays, CT scanners produce a series of images that can define disk and bone problems.
• Myelography This test involves the injection of a special dye into your spinal canal. After the injection, X-rays of your spine can reveal a herniated disk or other lesions.
• Magnetic resonance imaging (MRI) This test combines a strong magnetic force with radio waves. The result is computer-generated images of bones, muscles, cartilage, ligaments, tendons and blood vessels. MRI testing can identify herniated disks or other problems with your back.
• Electrical nerve conduction test (electromyography, or EMG) This diagnostic approach measures the electrical impulses produced by nerves as they connect from your spinal cord, through your spine and on down to your muscles. Studies of your nerve pathways can confirm nerve injury caused by herniated disks or spinal stenosis.
• Bone scan During a bone scan, a radiologist injects a radioactive substance (tracer) into one of your veins. Doctors then use a special scanner to locate bone tumors or compression fractures caused by osteoporosis.