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Back pain diagnosis and treatment

How do I know what is causing my back pain?

Before treatment can begin for back pain, a doctor or other specialist will need to diagnose what's causing the pain.

As well as a physical examination, and listening to a description of symptoms and pain triggers, blood and urine tests may be arranged to check for infections or other medical problems.

X-rays are useful in pinpointing broken bones or other skeletal defects. They can sometimes help locate problems in connective tissue. To analyse soft-tissue damage computed tomography (CT) or magnetic resonance imaging (MRI) scans may be needed, and your doctor will usually refer you to a back specialist to have these done. X-rays and imaging studies may be used for examining direct trauma to the back, back pain with fever or nerve problems such as extremity weakness or numbness. To determine possible nerve or muscle damage an electromyogram (EMG) can be useful.

X-rays and magnetic resonance imaging (MRI) studies have limitations and must be interpreted with caution. Back pain may be incorrectly attributed to non-specific and unrelated abnormalities on the images. Ordinary and expected wear and tear in the spine and discs may be mistaken as the cause of a person’s back pain. Similarly, plain X-rays are not usually helpful in cases of chronic back pain without a significant injury or loss of sensation and movement in the extremities.

Most back pain originates in the soft tissues of the back and not the actual spine. Because most back pain is related to the muscles of the back, the specific cause of most back pain cannot be determined by imaging studies.

What are the treatments for back pain?

Rest: The basic treatment for relieving acute back pain from strain or minor injury is a limited period of rest for 24 to 72 hours. An ice pack can be helpful, as can aspirin or another nonsteroidal anti-inflammatory drug (NSAID) to reduce pain and inflammation. After the inflammation subsides, applying heat can soothe muscles and connective tissue.

Long-term bed rest is no longer considered necessary for most cases of back pain - it can actually be harmful, slowing recovery and potentially causing new problems. In most cases you will be expected to start normal, non-strenuous activity (such as walking) within 24 to 72 hours. After that you should begin controlled exercise or physiotherapy. Physiotherapy treatments may include massage, ultrasound, whirlpool baths, controlled application of heat and individually tailored exercise programmes to help you regain full use of your back. Strengthening both the abdominal and back muscles helps stabilise the spine. You can prevent further back injury by learning - and doing - gentle stretching exercises and correct lifting techniques, as well as maintaining good posture.

Medication: If back pain keeps you from carrying out normal daily activities, your doctor can help by recommending or prescribing pain medications. Over-the-counter painkillers such as aspirin, paracetamol, ibuprofen or low-dose codeine phosphate and paracetamol combinations can be helpful. Your doctor may prescribe prescription strength anti-inflammatories/pain medications or may prefer to prescribe a combination of opioid and paracetamol based medications. Some doctors also prescribe muscle relaxants. However the main effect of these medications is on the brain, not the muscles, and they often cause drowsiness.

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