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Understanding Back Pain -- Diagnosis and Treatment

How Is Back Pain Diagnosed?

Before a doctor can begin treating back pain, he or she may do tests to diagnose what is causing your problem. Unless you are totally immobilized from a back injury, your doctor probably will test your range of motion and nerve function and touch your body to locate the area of discomfort.

Blood and urine tests may be done to be sure the pain is not caused by an infection or other systemic problem. X-rays are useful in pinpointing broken bones or other skeletal defects. To analyze soft-tissue damage such as disk herniation, magnetic resonance imaging (MRI) scans may be needed. A CT scan can be done instead for those who cannot have an MRI. X-rays and imaging studies are not usually indicated for first-time back pain caused by an overuse type injury and are generally used only for checking out ongoing pain, direct trauma to the back, back pain with fever, or nerve problems such as weakness or numbness in the arms or legs. To determine possible nerve or muscle damage, an electromyogram (EMG) can be useful.

Understanding Back Pain

 Unfortunately, there is not always a direct correlation between the findings on imaging studies and the amount of back pain. Many people have findings on CT scans and MRI, yet do not have back pain.

What Are the Treatments for Back Pain?

Back pain treatment goals are pain relief and restored movement. The basic treatment for relieving acute back pain from strain or minor injury is to modify your activities. An ice pack can be helpful, as can acetaminophen (Tylenol), aspirin or another nonsteroidal anti-inflammatory drug (NSAID) to reduce pain and inflammation. Never give aspirin to a child younger than 19 as it increases the risk of Reye’s syndrome. After the inflammation subsides, applying heat can soothe muscles and connective tissue.

Bed rest, which used to be advised for the treatment of back pain, is not only unnecessary for most cases of back pain, but it may actually be potentially harmful. It may slow recovery and cause new problems. In most cases, you will be expected to start normal, nonstrenuous activity (such as walking) within 24 hours to 72 hours. After that, controlled exercise or physical therapy may be helpful. Physical therapy treatments may employ massage, ultrasound, whirlpool baths, controlled application of heat, and individually tailored exercise programs to help you regain full use of the back. Strengthening both the abdominal and back muscles helps stabilize the spine. You can help prevent further back injury by learning -- and doing -- gentle stretching exercises and proper lifting techniques, and maintaining good posture.

If back pain keeps you from normal daily activities, your doctor can help by recommending or prescribing pain medications. Over-the-counter painkillers such as acetaminophen (Tylenol), aspirin, or ibuprofen (Motrin, Advil) can be helpful. Your doctor may prescribe prescription strength anti-inflammatories/pain medicines. For severe pain, he or she may prescribe combination opioid/acetaminophen pain medications such as hydrocodone/acetaminophen (Vicodin) or oxycodone/acetaminophen (Percocet). Some doctors also prescribe muscle relaxants. But beware, pain medications and muscle relaxants effect the brain, and often cause drowsiness and dependence. Other medicines such as antidepressants and anticonvulsants are sometimes prescribed to help with pain related to irritated nerves. Although sometimes used, steroids taken by mouth are not recommended by the American College of Physicians (ACP) for the treatment of acute low back pain.

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