Diagnosis of severe back pain

Minor pain and discomfort in the back are rarely perceived as a reason to visit a doctor, while severe pain simply forces a person to think about their health and seek help from specialists. However, in some cases, a more serious incentive is required to see a doctor: the presence of other suspicious symptoms or the lack of effect from the painkillers used for their own purposes.

The first doctor we rush to with complaints of various pains is a 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 narrow specialists:

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

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

It is very important to indicate what factors cause an increase or decrease in pain, and also to remember what preceded the appearance of pain syndrome for the first time (active training, injuries, hypothermia, severe stress, food intake, infectious diseases, etc.).

Studying the patient's history and complaints is only one component of the physical examination. Examination and palpation of the back can reveal various muscle compactions, 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 bring the shoulders together, lean forward or make other movements that allow the doctor to examine the bones of the spine in as much detail as possible without special equipment, assess 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, which allow identifying hematological disorders, infections, and in some cases, suspecting oncological diseases. The presence of cancer is confirmed by performing a biopsy followed by histological examination of the biomaterial.

The presence of inflammatory processes in the body is also confirmed by a blood test, although without specifying the location. If we are talking about back pain just above the waist, the doctor will most likely issue a referral for a urine test to exclude or confirm diseases of the liver, which are almost always accompanied by spinal pain of varying intensity.

If the pain is localized in the area of the shoulder blades, neck, shoulder blades, lower back, instrumental diagnostics are designed to clarify the situation and help in making a diagnosis, namely:

• electrocardiogram (allows to confirm or exclude cardiovascular diseases, in which pain can radiate to the back),
• X-ray of the back or specific parts of it (helps to identify traumatic injuries, tumor and inflammatory processes, degenerative changes in bones and joints, the presence of foci of tuberculosis of the lungs or bones),
• computer tomography (it can be used to obtain three-dimensional images of bone structures if a diagnosis needs to be clarified),
• magnetic resonance imaging and ultrasound examination (allow to assess the condition of not only bones, but also soft tissue structures: muscles, ligaments, cartilage, nerve fibers),
• electromyography (study of the state of nervous tissue by assessing their electrical conductivity and muscle reaction is relevant in radicular syndrome caused by compression of the nerve by an intervertebral hernia or as a result of spinal canal stenosis),
• bone scintigraphy (scanning of bone tissue to assess their condition in osteoporosis and suspected bone tumors).

If gynecological problems are suspected, the patient is referred to a gynecologist who will conduct an examination on the chair, take a smear for microflora, and, if necessary, send for an ultrasound of the pelvic organs. The same study is relevant for pathologies of the urinary system. If kidney stones are suspected, it is advisable to additionally do an ultrasound of the kidneys. But if back pain is caused by problems with the digestive system, the patient is referred to a gastroenterologist, having previously prescribed such studies as ultrasound of the abdominal organs and FGDS.

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

Differential diagnostics in case of severe back pain is important already because it allows to identify pathologies requiring immediate treatment (for example, malignant tumors). A correct diagnosis of spinal pathologies 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 pain is typical for traumatic injuries of bones and nerves, but chronic, regularly recurring or constant pain corresponds to infectious and inflammatory, degenerative and especially tumor processes. Moreover, in the latter two cases, the intensity and duration of the pain symptom gradually increases, which indicates the progression of the pathology.

Since reflected back pain can occur along with local pain, a thorough approach to diagnosis will help to identify hidden diseases of internal organs. In this case, the results of laboratory tests and instrumental diagnostics are very informative. If they are ignored, the spine can be treated in vain and painkillers can be taken, while the patient may begin to perforate an ulcer, which, in the absence of rapid and effective treatment, can lead to death.

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