Why Does Your Back Hurt?

These are some of the imaging tests you may need to find the source of your back pain.

Back pain is the leading cause of disability worldwide and it is estimated that about 80% of the population will experience it at some point in their lives. In many instances, pain in your back is a minor annoyance that goes away after a few days of rest or modified activity. But if you have back pain that is severe, doesn’t go away after a few days or goes away only to come back again, it may be time to see a doctor.

What can I expect during my office visit?

During your initial office visit, your doctor will ask questions about your medical history and will inquire about the specifics of your back pain. You’ll likely be asked to share where the pain is located, when the pain started, what you were doing when the pain began (or shortly before you had pain), what causes the pain to be better or worse and what you have done so far to try to treat your pain.

The doctor will also perform a physical exam and will likely test your neurological function. Your range of motion will be checked and your doctor will test your muscle strength, reflexes and whether the pain travels to other parts of your body.

You may also be referred for additional imaging tests so the doctor can get a better look at the bone and soft tissue of your spine and surrounding area. The most common imaging tests to diagnose the source of back pain include x-rays, CT scans and MRIs. These non-invasive tests allow a doctor to see the internal structures of your back.

Will I need an x-ray?

X-rays are often the first type of imaging test ordered if an underlying bone injury or condition is suspected. This test is quick and non-invasive and allows the doctor to see a two-dimensional picture of your bones. An x-ray may uncover a fracture, bone spur, osteoarthritis or spinal alignment problem.

Will I need a CT scan?

A Computerized Axial Tomography scan, also referred to as a CT scan or CAT scan, is more effective at showing the soft tissue in your spine, such as ligaments and muscles. This imaging test may be ordered if your doctor suspects your back pain is due to a bulging, herniated or ruptured disc, spinal stenosis, tumor or spinal cord infection.

Will I need an MRI?

A Magnetic Resonance Imaging test, or MRI, uses magnets to create a detailed image of a cross-section of your body. This non-invasive imaging test provides clearer images of soft tissue, such as ligaments, tendons, muscles, cartilage and discs, as well as blood vessels and bones. In many cases, an MRI will not be ordered until after the results of an x-ray or CT scan have been reviewed.

Are there other imaging tests I may need?

Although x-rays, CT scans and MRIs are the most common types of imaging tests ordered for people with back pain, there are other tests that may also be appropriate, depending on the suspected source of your back pain. These include:

• Bone scan – This exam involves injection of a small amount of radioactive dye into a vein in your arm. The dye is absorbed by your bones and then the area in question is scanned to detect “hot spots” where there is more radioactive material. This indicates an increase in blood flow or inflammation and may uncover a fracture, infection or tumor.
• Discogram – This test provides a clearer image of the internal structure of a disc in your spine. During the exam, dye is injected into the disc being examined and then a CT scan is performed. The dye makes tears, scars or changes in the disc more apparent in the scan.
• Myelogram – This imaging test involves injection of a dye around your spinal cord and nerves, followed by an x-ray or CT scan to provide a detailed image of your spinal cord. The results help identify abnormalities.
• DEXA scan – A Duel Energy X-Ray Absorptiometry, or DEXA scan, is used to diagnose osteoporosis. The imaging test uses a small amount of radiation to evaluate the density of the bones in the spine.

If you have chronic or severe back pain, visit your doctor for an exam and to discuss whether any of these imaging tests are needed to uncover the source of your pain so you can begin treatment.