The management of back pain should involve specialists including internists, orthopedists, pain specialists
, and others.
Back pain is a common complaint and a reason is often not clear for the majority of patients. Careful evaluation by a doctor helps determine those who may have a more serious problem and require further evaluation. Certain diagnostic tests may help guide management strategies and help improve outcomes. These imaging studies are not always indicated and may include X-rays, MRI, CT, myelogram, electromyography, bone scans, or others.
Discography is a test in which contrast is injected under X-ray guidance into the center of a disc (cartilage between two vertebrae) which is thought to be causing the patient's pain. If contrast is seen coming out through tears in the disc on X-ray after injection, then this disc is thought to be the culprit for the patient's pain. However, this diagnostic modality has not been clearly validated and may not reliably identify patients with pain related to their discs. Potential complications include infection, headache, worsening of back pain, accelerated disc degeneration, and disc herniation. The test is not routinely recommended as a result but may be used by health care providers for certain cases.
It is not possible to make a diagnosis or develop a treatment plan without seeing the patient. It is therefore the recommendation to seek a referral to an orthopedist or pain physician to be evaluated in person.