Diagnosis of severe back pain

Insignificant pain and discomfort in the back are perceived by few as a reason to visit a doctor, while severe pain simply makes a person think about his health and seek help from specialists. However, in some cases, a more serious stimulus is required to go to a doctor: the presence of other suspicious symptoms or the lack of effect of the anesthetic drugs used for one’s own purpose.

The first doctor to whom we hurry with complaints of various pains is the therapist (in the case of a child, a pediatrician). It is this specialist who must make a preliminary diagnosis and, if necessary, refer the patient to a narrow specialist:

• a neurologist (if the neurological nature of the pain is suspected),
• traumatologist (if the pain was preceded by a trauma), orthopedist or spine (doctors specializing in spinal diseases, including their complications),
• an oncologist (if there are reasons to suspect a tumor process),
• cardiologist (suspected cardiovascular disease)
• hematologist (when it comes to blood diseases, including hereditary),
• urologist, gynecologist, gastroenterologist, etc. (in case of suspicion of the reflected nature of pain caused by diseases of the urinary, genital and digestive systems).

Only the patient or his relatives can help the therapist to make the right choice, having described the nature of the pain syndrome, its localization, and associated symptoms (headaches, nausea, fever, etc.) in as much detail as possible.

It is very important to indicate which factors cause the increase and reduction of pain, as well as recall what preceded the appearance of pain for the first time (active training, injuries, hypothermia, severe stress, eating, infectious diseases, etc.).

The study of the history and complaints of the patient is only one of the components of the physical examination. Examination and palpation of the back can detect various muscle compacting, changes in the size of the vertebrae and the shape of the spine. To clarify the diagnosis, the patient will be asked to straighten or reduce his shoulders, lean forward or make other movements that allow the doctor to examine as closely as possible without special equipment the spine bones, evaluate the shape of the spinal column, as well as its mobility.

The patient is prescribed standard tests. In most cases, they are limited to blood tests that allow to detect hematological disorders, infections, and in some cases to suspect cancer. The presence of cancer is confirmed by biopsy, followed by a histological examination of the biomaterial.

The presence of inflammatory processes in the body is also confirmed by a blood test, however, without indicating the place of their localization. If we are talking about back pain just above the lower back, the doctor is likely to give a referral for urinalysis to exclude or confirm the diseases of the stoves, which are almost always accompanied by spinal pain of varying intensity.

If the pain is localized in the area of the shoulder blades of the neck, shoulder blades, lower back, an instrumental diagnosis is to help clarify the situation and to help in the diagnosis, namely:

• electrocardiogram (allows you to confirm or exclude cardiovascular diseases in which pain can radiate to the back),
• radiograph of the back or of its specific sections (helps to identify traumatic injuries, tumor and inflammatory processes, degenerative changes in bones and joints, the presence of foci of pulmonary tuberculosis or bones),
• computed tomogram (with its help you can get three-dimensional images of bone structures, if you need to clarify the diagnosis),
• magnetic resonance tomogram and ultrasound (allow to assess the condition of not only bones, but also soft tissue structures: muscles, ligaments, cartilage, nerve fibers),
• electromyography (the study of the state of the nervous tissue according to the assessment of their electrical conductivity and muscle response is important when the radicular syndrome is provoked by squeezing the nerve of the intervertebral hernia or due to spinal canal stenosis),
• bone scintigraphy (bone scan to assess their condition in osteoporosis and in case of suspected bone tumors).

If you suspect a gynecological problem, the patient is sent to a female doctor, who will examine the chair, take a smear on the microflora, and, if necessary, refer to an ultrasound of the pelvic organs. The same study is relevant for pathologies of the urinary system. If you suspect kidney stones, it is desirable to additionally make an ultrasound of the kidneys. But in case back pains are caused by problems with the digestive system, the patient is referred to a gastroenterologist, having preliminarily assigned such studies as ultrasound of the abdominal organs and FGDS.

There are many reasons for the onset of pain, but pain of a certain intensity and localization alone is not sufficient evidence of the presence of a certain disease. Diagnosis and subsequent  treatment of severe back pain requires a professional approach, which allows differentiating diseases with similar symptoms of pain syndrome and prescribing those therapeutic measures that will correspond to the existing health problem.

Differential diagnosis in the event of severe back pain is important already because it allows you to identify pathologies that require immediate treatment (for example, malignant tumors). Correctly diagnosed with pathologies of the spine, taking into account the data of instrumental studies, allows to slow down the development of the pathological process, and in some cases save a person from possible disability.

It is important to distinguish between acute and chronic pain syndrome. Acute sudden pains are characteristic of traumatic injuries of bones and nerves, but chronic, regularly recurring or persistent pain correspond to infectious-inflammatory, degenerative, and especially tumor processes. Moreover, in the last two cases, the intensity and duration of the pain symptom gradually increases, indicating that the pathology progresses.

Since, along with local back pain, there can be reflected, a thorough approach to diagnosis will help to reveal the diseases of the internal organs hidden from the eyes. In this case, the results of laboratory studies and instrumental diagnostics are very informative. If they are ignored, it is possible to treat the spine in vain and take painkillers, while the patient may have ulcer perforation, which, in the absence of quick and effective treatment, can be fatal.

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