Diagnosing and Treating Lower Back Pain

The best way to get an accurate diagnosis for what’s causing low back pain is to go a major medical center with an experienced team of spine specialists. A skilled team is necessary for proper diagnosis and treatment because the source of low back pain can often be difficult to determine for many reasons.

Different conditions that lead to low back pain have similar symptoms. Conversely, symptoms of the same condition tend to vary. Adding to the difficulty of receiving an accurate diagnosis is the fact that many low back conditions are asymptomatic, meaning they cause no symptoms at all but require medical attention nonetheless.

A person may also have “referred pain.” Referred pain is pain that is felt in one area of the body but originates from another. (A good example is the left-arm pain a person may experience while having a heart attack.) A person with referred pain that originates in the spine may come to a doctor experiencing pain in only the leg and foot. Referred pain is different from radicular pain, the kind experienced with sciatica, for example, in which the pain radiates down the path of the irritated nerve.

A diagnosis of what is leading to lower back pain starts with a doctor getting a complete medical history, along with asking the individual about the site(s) and severity of the pain and the duration and onset of the symptoms. Neurological tests are performed to locate weakness in the muscles and enhanced or diminished pain based on position of the body and movement. Blood tests and further medical workup may be needed if the pain is severe and affects a person’s day-to-day life, including the ability to get a good night’s rest. Some of the tests used to diagnose low back pain are:

• Blood tests may be ordered to search for the HLA-B27 gene, which is carried by more than 95 percent of those with ankylosing spondylitis, a form of arthritis in which chronic inflammation causes stiffness and pain in the spine.
• Computerized tomography (CT) is a noninvasive procedure that uses X-rays to produce a three-dimensional image of the spine. A CT reveals more details such as bony anatomy than an X-ray.
• Electromyography and nerve conduction studies (EMG/NCS) may be used to measure the electrical activity in the nerves and muscles. It can be used to identify nerve damage or nerve compression.
• Magnetic resonance imaging (MRI) uses magnetic fields and radio-frequency waves to create an image of the spine that reveals the discs, nerves, spinal canal, and other details that can’t normally be seen on an X-ray. Sometimes a contrast agent is injected into a vein in the hand or arm during the test, which highlights certain tissues and structures to make details even clearer. An MRI can also reveal previous injuries.
• Myelogram uses a dye that is injected directly into the spinal column and is used in conjunction with an X-ray or CT scan. It can be used to identify a herniated disc. It is sometimes used when a patient cannot obtain an MRI.
• X-rays are often the first imaging test used. They can usually reveal broken bones, abnormal alignment and curvature, or injured vertebrae, but cannot show soft tissue problems such as bulging discs, or issues with muscles or ligaments.

Once a diagnosis has been confirmed at Och Spine at NewYork-Presbyterian at the Weill Cornell Medicine Center for Comprehensive Spine Care, a person with low back pain will receive an individualized treatment plan from our team of specialists.

Treatment Options

Treatment for back pain will vary depending on its cause and the severity of pain. Treatment options should be conservative at first, starting with home remedies and medical therapies, before surgery is considered. The Spine Center offers a full range of nonsurgical treatment options before surgery is considered, including:

Home Remedies: Lower back pain that’s due to muscle or ligament strain will often get better on its own with time, self-care, and home remedies such as:

• Hot or cold compresses
• Over-the-counter pain medication such as ibuprofen and acetaminophen
• Reduced activity and rest
• Specific back exercises and/or stretching routines

Medical Therapy: In cases where there is structural damage to the spine, the following medical therapies can help:

• Alternative treatment like acupuncture and massage
• Bracing to stabilize the spine and reduce pain
• Injections of anti-inflammatory medication
• Muscle relaxants
• Physical therapy to strengthen the core muscles surrounding the spine and encourage newer pain-free ways of moving.
• Prescription medications for pain, including non-steroidal anti-inflammatory medications (NSAIDs) and opioids
• Steroids

Surgical Treatment: The goal of surgery is to relieve pain and other neurologic symptoms and promote a person’s mobility. In some cases, surgery is needed to stabilize the spine. Only in rare situations is immediate surgery required for low back pain. The neurosurgeons of the Spine Center may recommend surgery if:

• Conservative treatments prove ineffective.
• The pain is so severe that it is debilitating.
• It is difficult to stand or walk.

Find out more about surgery for lower back pain.

Because the causes of back pain are sometimes hard to identify, it is important to be seen by a specialist to be properly diagnosed and treated. At Och Spine at NewYork-Presbyterian at the Weill Cornell Medicine Center for Comprehensive Spine Care, our specialists have advanced training in diagnosing and treating conditions of the spine. They believe in an interdisciplinary approach to treating back pain, including physiatry, pain management, physical therapy and – only when necessary – surgery.