Initial exam for low back pain

Your doctor will begin by asking questions about your medical history, your symptoms, and your work and physical activities. He or she will also do a physical exam. The questions and exam can help him or her rule out a serious cause for your pain. Your doctor may also ask questions about stress at home and at work that may make you more susceptible to chronic pain.

For most people with low back pain, the doctor will be able to recommend treatment after the initial exam. Your doctor will probably recommend that you begin home treatment and possibly physical therapy.

If you are older than 50 or you have symptoms of a specific illness, your doctor may recommend more tests.

Tests for low back pain

If your initial exam shows no signs of a serious condition, you will probably not need to have an imaging test. Imaging tests are typically done if:

• You are more than 50 years old.
• You have had spine problems since birth (congenital spine problems).
• The history and physical exam reveal signs of a serious problem, such as a fracture, tumor, infection, or severe nerve damage.
• You have a history of any type of arthritis in your spine.
• You have a history of a previous spine injury or back surgery.
• You have a history of long-term steroid use or a history of drug abuse.
• Back pain has not improved, or symptoms have gotten worse, after at least 4 weeks of home treatment that may include pain relievers, ice, and exercises.
• You have had several episodes of severe pain.
• You and your doctor are considering surgery.
• Workers' compensation is involved because you had an injury on the job.
• You are involved in a lawsuit concerning your injury.

The type of imaging test will depend on what kind of problem your doctor suspects. You may have one or more tests, such as:

• Spinal X-ray.
• MRI.
• CT scan.
• Bone scan.

For more information about MRI for low back pain, see:

Should I have an MRI for low back pain?

Imaging tests such as the myelogram and discography have been largely replaced by simpler and more effective methods for basic testing. They are sometimes still used in hard-to-diagnose cases or before surgery. If your doctor recommends discography, experts recommend getting a second opinion before having the test.

If you have leg pain or numbness, you may have an electromyogram and nerve conduction studies to find out how severely your nerve function is being affected. Electromyogram and nerve conduction studies check the function of the spinal cord, nerve roots, and nerves and muscles that control your arms and legs.

Blood tests are sometimes used to look for a metabolic disorder, arthritis, cancer, or an infection. Bone scans may also be used to look for cancer or infection.