Performance Physical Therapy

4 Big Reasons Why Back Pain Is Hard to Diagnose

A healthcare professional is examining a patient's back in a clinical setting with a treatment table and various physiotherapy equipment in the background. The patient is sitting on the table while the practitioner, wearing a blue shirt, is palpating the patient's lower back area. A shelf with folded towels and dumbbells is visible in the background, adjacent to a desk with a laptop.

While back pain is extremely common, it is also hard to diagnose because there is no established guideline or protocol for evaluating this problem. Furthermore, a typical 15-minute doctor’s visit is usually inadequate to explain, understand, and evaluate everything that’s going on in your aching back.

Diagnosis of the underlying reason of back pain takes time, physician expertise, and collaboration among various medical professionals, including primary care physicians, physical therapists, physiatrists, and orthopedic physicians, to name a few.

The following are four big factors why a back problem diagnosis may fail or be overly delayed:

1. It can be difficult to identify the source of pain.

There are numerous potential underlying causes of back pain:

  • Anatomical structures such as spinal nerve roots, lower back muscles, vertebral bones and joints, intervertebral discs, and/or abdominal organs may experience problems.
  • In some cases, your nerves may send abnormal pain signals to your brain, resulting in neuropathic back pain.
  • Psychosocial factors such as stress, depression, and/or anxiety may also have an impact on back pain.

Because of the presence of multiple problems, determining the exact cause of a back problem can be difficult. For example, a patient may have both a herniated disc and spinal stenosis, and the pain could be caused by either of these conditions. However, treatment options differ for both, and providing an incorrect treatment will not help to eliminate the source of pain.

2. Diagnostic tests are of limited effectiveness.

When it comes to diagnostic tests, there are numerous potential issues. The most serious issue is that there is no single diagnostic test that can provide an accurate diagnosis of back pain. As a result, many diagnostic tests are of limited effectiveness, and some, such as diagnostic nerve block injections, may produce false-positive or false-negative results.

Of course, this does not mean that your specialist can not diagnose your back problem. Certain common conditions, such as a lumbar herniated disc that causes sciatica symptoms, can frequently be diagnosed quickly and accurately using tests such as clinical tests, questions, and medical imaging scans.

The inadequacy of any single diagnostic test, on the other hand, helps to explain why you may receive different diagnoses from different doctors.

3. Pain is an entirely subjective experience that varies greatly.

Each person’s experience with pain is distinctive. What may appear to be minor back pain to one person may appear to be severe and overwhelming to another. As a result, different people may require completely different types and levels of treatment for the same condition. For example, for most people, over-the-counter medication and/or exercise may be sufficient to treat the pain from a common back condition. However, your subjective experience may indicate that you require a more robust treatment plan, such as an epidural steroid injection, to manage your severe pain.

4. Your lifestyle may be a hidden cause

Even if you receive an accurate diagnosis and treatment plan, your back pain may persist, recur, or worsen over time. Sedentary lifestyle, smoking, excessive consumption of inflammatory foods and/or alcohol, and insufficient sleep may be a few of the hidden causes. Stress and anxiety, can cause or worsen existing back pain.