Investigations for Back Pain
Unfortunately, despite the fact that many people ask for a scan "to see where the pain is", no such scan exists. Frequently, scans and other investigations will show up abnormalities that are not relevant to the pain someone is feeling. To put this into perspective, every person at 50 has abnormalities on scanning the back or neck. Without carefully considering a scan in correlation with the patient's back pain symptoms and physical examination it would be very easy to do the wrong treatment and potentially leave the patient worse off.
We therefore do investigations in the context of an individual patient's symptoms and signs, normally to assess with particular regard to whether an operation or other specific intervention might help. "Going fishing" with an XRay or scan is rarely helpful.
Common Diagnostic Investigations
The most common diagnostic tests include:
X-ray. This test provides information on the bones in the spine. The evidence, though, is that plain X rays of the spine are rarely useful and the recommendation from the Royal College of Radiologists is that plain x-rays should not be used in routine assessment of back pain. They may sometimes be used in specific circumstances for specialist assessment.
CT scan. This test is a very detailed x-ray that builds cross-sectional images from multiple x-rays taken at a range of angles round the body. CT scans provide details about the bones in the spine. They may also be used to check for specific conditions, such as a herniated disc or spinal stenosis. CT scans tend to be less accurate for spinal disorders than MRI scans. Useful further information about CT scanning is given here.
MRI scan. An MRI scan is particularly useful to assess certain conditions by providing detail of the intervertebral disc and nerve roots (which may be irritated or pinched). MRI scans may be useful to rule out spinal infections or tumors. A useful link to further information about MRI scans is given here.
Blood Tests. We will, if the clinical presentation of the pain suggests it is necessary, sometimes do blood tests such as Erythrocyte Sedimentation Rate (ESR) or blood viscosity to look for inflammatory conditions, or blood tests to look for abnormal proteins in the blood in conditions such as myeloma, a malignant condition which can cause back pain.
Diagnostic Injections may also be used to help diagnose certain types of pain. If an injection of a pain relieving medication into a certain spot in the spine provides pain relief, than it may help to confirm that is the area causing pain.
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Pain Service Website, Gloucestershire Hospitals NHS Foundation Trust
Webmaster Dr J G de Courcy, Consultant in Pain Medicine and Anaesthesia
Page updated 15/02/2016