Solving the Enigma of Back Pain

Solving the enigma of back pain continues to be difficult. The issue conjures up an image of a huge grey spectrum with the myriad of diagnosticians making educated guesses, at best for most patients. One must consider that the majority of back patients improve with no treatment at all. The fact is that no foolproof method exists to divide the majority of back pain sufferers into like groups so that members of each group could be subjected to the different treatments and the success of each treatment measured and evaluated.

Two of the most frequent tools used to look at anatomical anomalies and associated back pain include the X-Ray and the MRI. Though the MRI will show much more detailed images, usually the X-Ray images will be sufficient enough to make an evaluation. Here is another stumbling block to the back pain enigma - more than 50% of people over the age of 40, and many even younger than 30, have structural abnormalities in their spine of some kind. And not all of the patients, even those with significant structural damage, have pack pain. What's more, many people with clean X-Ray images and MRIs of their spine and pelvis have extreme, debilitating back pain. What does the medical profession do with these patients?



Dr. Carl Sutton, director of orthopedic surgery at St. Mary's Hospital in Montreal, explains the difficulties at determining the cause of back pain using radiographic imaging: "If you were to put 300 randomly chosen spinal X-Rays up on a screen, you' find that in about half of them, there would be degenerative signs of degenerative changes - general wear and tear, narrowing of disc spaces, arthritic changes. You'd also likely find that 150 of those 300 patients had arthritic changes. But the crazy thing is that there would likely be very little, if any, relationship between those that are in pain and those who have signs of degenerative changes…I've seen X-Rays of backs that look as if they should belong to veritable cripples, and yet the person has no pain at all. By the same token, I've seen patients whose X-Rays look perfectly normal but who suffer from severe back pain."

For these reasons mentioned above, finding the cause of back pain and making a clinical diagnosis may be challenging. The cause of your back pain may depend on how your foot hits the ground when you walk, the way you hold your head and shoulders while you sit down and work, your nutrition, your intervertebral discs, etc. What a diagnostician looks for depends, for one thing, on their training bias. An orthopedic surgeon, for example, will look for gross abnormalities which are correctable by surgery; performing surgery is the orthopedic surgeon's job. A physical therapist, on the other hand, is more likely to gravitate toward soft tissue problems, such as the muscles and ligaments that support the back. A chiropractor, is more likely to look at the alignment of the spine and angle of curvature, as well as posture and kinesthesiology. Holistic practitioners, who do not have access to sophisticated equipment of testing of the blood, are more likely to describe structural imbalances or nutritional deficiencies. Based on who you go to see for your back problem, you might be prescribed anything from vitamins and herbs to removal of pieces of your backbone. Indeed, the people you see and the diagnoses for your back problem will have a major effect on how it is treated, and how long it takes you to recover.