Find Information About:

Drugs & Supplements

Get information and reviews on prescription drugs, over-the-counter medications, vitamins, and supplements. Search by name or medical condition.

Pill Identifier

Pill Identifier

Having trouble identifying your pills?

Enter the shape, color, or imprint of your prescription or OTC drug. Our pill identification tool will display pictures that you can compare to your pill.

Get Started

My Medicine

Save your medicine, check interactions, sign up for FDA alerts, create family profiles and more.

Get Started

WebMD Health Experts and Community

Talk to health experts and other people like you in WebMD's Communities. It's a safe forum where you can create or participate in support groups and discussions about health topics that interest you.

  • Second Opinion

    Second Opinion

    Read expert perspectives on popular health topics.

  • Community


    Connect with people like you, and get expert guidance on living a healthy life.

Got a health question? Get answers provided by leading organizations, doctors, and experts.

Get Answers

Sign up to receive WebMD's award-winning content delivered to your inbox.

Sign Up

Back Pain Health Center

Font Size

Back Pain Test Not Proof of Spine Trouble

Mental, Social Distress Predicts Pain Better Than Disc Injection Test
WebMD Health News

May 17, 2004 -- Some say disabling back pain with no obvious cause is a spinal disc problem. Some say it's a mental problem. Both may be right.

When all else fails to stop lower back pain, doctors consider spinal fusion surgery. To find out exactly where the problem is, they use a process called discography. During discography, a doctor injects dye into suspect spinal discs. These discs normally act to cushion bones in the spine. If the procedure hurts, surgery may be needed in the future -- especially if MRI images show small tears in a disc.

How good are these tests? Not great, suggests orthopaedic surgeon Eugene Carragee, MD, director of the spine surgery service at Stanford University in Palo Alto, Calif. In a new study, Carragee and colleagues find that psychological distress and pre-existing pain predict lower back pain better than discography or MRI.

"Psychological distress, a history of a disputed workers' compensation claim, and other chronic pain processes do predict later lower back pain," Carragee tells WebMD. Although structural findings such as a crack in the disc seen on MRI seemed to predict back pain, he says this is a borderline finding.

A Controversial Test

There are two schools of thought regarding unexplained back pain. Some doctors say it's a matter of looking more closely at a patient's spine. Others say it's a matter of looking more closely at a patient's psychological status.

Carragee and colleagues set up a clever study. They performed physical and psychological tests on the kinds of people who tend to show up in back surgeons' offices -- before they had any back pain. Subjects included people who had earlier surgery for neck pain, patients with psychological distress who complained of physical ailments, and patients who'd had disc surgery for sciatica.

Even though none of these subjects had back pain, half of them underwent discographic injection and all of them underwent MRI and X-rays. Four years later, the researchers checked to see which subjects now were having lower back pain.

The bottom line: Not all subjects who felt pain on discographic injection went on to develop back pain. Not all subjects who actually had tears in lower-back discs complained of back pain. But patients who tended to experience chronic pain and patients who were under psychological distress were most likely to have back pain four years later.

1 | 2 | 3

Today on WebMD

Woman holding lower back
Or is it another form of back pain?
Hand on back
See the myths vs. the facts.
Woman doing pilates
Good and bad exercises.
acupuncture needles in woman's back
Use it to manage your pain.
Man with enhanced spinal column, rear view
pain in brain and nerves
Chronic Pain Healtcheck
Health Check
break at desk
Woman holding lower back
Weight Loss Surgery
lumbar spine
back pain