Diagnosing Back Pain
Back pain occurs for many reasons. The first step in treating back or neck pain is to identify exactly what is causing it. So before we can diagnose your condition and design a treatment plan, a complete medical history and physical examination are necessary. This gives us a clearer picture of what’s causing your back or neck problem, and whether additional diagnostic tests are needed.
If further tests are needed, we have all the most advanced technology available right here at our center, so everything usually can be done in one visit. These diagnostic tests include:
- Electromyography (EMG) – An EMG tests the electrical activity of the muscles in your arms and legs to reveal how your peripheral nerves (nerves in the arms or legs) are functioning. It can show if and how severely a nerve is pinched, and precisely where the problem is located. Using tiny needles, the EMG tracks the electrical impulses coming from the brain and/or spinal cord to the affected area.
- Nerve conduction study – This test is usually done before an EMG. Electrodes are placed on your skin over a nerve that the doctor wants to study. A small electrical impulse passes through one electrode at a time and the equipment measures any resulting electrical activity. When the speed of the signal is very slow, it indicates a likely nerve problem.
- Facet joint injection – The facet joint injection is both a test and a type of treatment. For the test, a local anesthetic (numbing) medication is injected into one or more facet joints (the joints where the vertebrae of the spine connect to one another, and which allow your back and neck to move in different directions). The medication numbs the area around the facet joint. If your pain goes away, it helps confirm the joint(s) as the source of your pain.
- Magnetic resonance imaging (MRI) – The MRI scan is an imaging test that enables us to see the anatomy (the physical shape and structure) of your spine to better understand if there’s a physical abnormality that’s causing your back or neck pain. We compare the findings on the MRI scan with the signs and symptoms of your pain in order to narrow down a clinical diagnosis. MRI scans are especially useful for providing detail of the disc and nerve roots, and to rule out tumors or spinal infections.
- Computed tomography (CT) – CT scans are essentially a very detailed x-ray. They take cross- section images (like “slices”) of the body that provide excellent detail of bones, and are often used for imaging of specific conditions, such as a herniated disc or spinal stenosis.
- X-rays – X-rays provide detail of the bone structures in the spine, and are used to check for instability (such as spondylolisthesis), tumors and fractures.
- Discogram (Discography) – This test involves inserting a needle into a disc under x-ray guidance and injecting a small amount of dye. If the injection causes your usual pain, it’s an accurate indicator of which disc(s) is/are causing your ongoing back pain. The dye makes the disc clearly visible on X-ray, revealing if it has begun to rupture or has tears (the type of structural damage that is a main cause of disc pain).
Treating Back Pain
There are many different ways to treat back pain. Surgery is rarely the first line of treatment. In fact, our goal is to help you avoid surgery whenever possible. That’s why we offer access to a full range of conservative (non-surgical) and minimally invasive ways to relieve back and neck pain. Your treatment is personalized to address your individual symptoms and lifestyle.
The conservative treatment options for back pain include:
- Osteopathic manipulation – A trained osteopathic physician provides hands-on adjustments of the spinal joints to alleviate pain, restore function and promote health
- Physical therapy – Targeted exercises to strengthen your back and core (the muscles that stabilize, align and move the trunk of the body, especially the abdominals and muscles of the back). Sometimes physical therapy is performed in a swimming pool; this is called aquatic therapy.
- Chiropractic – Manipulation and adjustment of body structures, including the spinal column, to relieve pain and restore function
- Therapeutic massage – Manipulation of the soft tissue structures of the body to prevent and relieve pain, muscle spasm and stress, and to promote health and wellness
- Complementary therapies including massage, acupuncture, mind-body practices like yoga and Pilates, herbal medications and dietary supplements
- Orthotics – A brace, splint or similar device used to support, align or hold parts of the body in the correct position, or prevent incorrect movement
- Prescription medications to relieve pain and/or relax muscles
Additional medical interventions (types of treatment) include:
- Trigger point or ligament injections involve injecting anesthetics or corticosteroids (anti-inflammatory medicines used to relieve pain) into the painful area, either in ligaments or "trigger" points to reduce pain and inflammation. A trigger point is a tight band of muscle that can refer pain to various parts of the body. Referred pain is when you feel pain in an area away from the actual source of the pain.
- Epidural steroid injections (ESI) involve injecting corticosteroids directly into the space around the spinal cord and nerve roots known as the epidural space (this is not the same as epidural anesthesia given to a woman before childbirth). Your doctor may recommend an ESI if you have pain that spreads from your spine to your hips or down the leg, and your pain has not improved with medicines, physical therapy or other non-surgical treatment.
- Facet joint injection (facet block) is both a test and a type of treatment. For the treatment, a local anesthetic (numbing) medication plus a corticosteroid is injected into the facet joints of the spine to reduce inflammation, which can often provide long-term pain relief. The facet joints are where the vertebrae of the spine connect to one another, and which allow your back and neck to move in different directions. The procedure may also be called a facet block, since its purpose is to block pain.
Some of these treatments (those in boldface) are offered here at our office. We also have a network of trusted providers in the community to whom we can refer you for treatments not available here. This way, we can match you with the most appropriate provider, and you can receive ongoing care more conveniently close to home.
When Surgery is Needed
When surgery is appropriate and necessary, the MMC Spine Program is affiliated with northern New England’s largest and most experienced team of neurosurgeons, so we can quickly and easily schedule a consultation for you – often the same day you see us for a diagnostic evaluation.
These highly-trained neurosurgeons have advanced expertise in minimally invasive spine surgery, performing more than 2,000 spine surgical procedures a year.
Surgeons from two private orthopedic practices also perform spine surgery at Maine Medical Center, and work closely with our neurosurgeons on complex cases, such as adult and pediatric scoliosis.