Some diagnoses of all your back pain symptoms are best guesses. They are subject to further diagnostic procedures, or they will be proven or disproved by the passage of time.
Take the case of a journalist who gritted her teeth and put up with many years of back pain until the symptoms finally overcame her. On the basis of X-rays and a clinical examination, an orthopedic surgeon told her she had a ruptured disc requiring surgery. (In fact X-rays are usually ineffective in diagnosing a ruptured disc because the discs themselves cannot be seen on conventional X-rays.)
“The diagnosis of my back pain symptoms terrified me,” she recalled. “In retrospect, I feel that it amounted to a misdiagnosis, since I got well without surgery.”
Whether the diagnosis was incorrect will never be known. What is known, though, is that it was a tentative diagnosis. The back pain symptoms in the journalist’s legs could have been caused by any one of numerous conditions.
Another back pain sufferer, a businessman, had the wits scared out of him by five diagnoses, none of which was based on concrete evidence: ruptured disc, spinal tumor, compressed nerve in low back, deteriorated disc, and Wilson’s Disease (a serious and rare neurological disorder) – all from the exact same set of back pain symptoms.
There is nothing intrinsically wrong with tentative diagnoses. They can simply indicate that your first visit, which usually consists of history-taking, direct examination and X-rays, signals the need for further diagnostic procedures.
So don’t panic needlessly about think-aloud diagnoses when the doctor first hears of your back pain symptoms. They tend to be less accurate than weather forecasts. They can also give you a headache that will make your back pain seem mild in comparison. And they turn diagnosis into a multiple-choice format. “It could be a disc, a facet joint, some arthritis or a pinched nerve – often without regard for the patient’s feelings.”
In fact, the way you are told about a tentative diagnosis can be frightening, even debilitating. It is one thing to say, “you may have a ruptured disc, Ms Jones.” But it is quite another matter to say, as a handful of doctors in a recent US survey did before solid evidence was in hand, “Have an operation now or you’ll be pleading for help in a few years.”
Many practitioners don’t bother telling patients whether diagnoses based on their back pain symptoms are tentative or documented. As a result, the patient may leave the office badly shaken, rather than informed, with a first-hand and unwelcome opportunity to learn about the role of stress in back pain.
Interpreting Back Pain Symptoms
With a doctors view of your back pain symptoms, what they see may not be what you’ve got
A renowned physician at a New York medical center treated a guy named James. After reviewing his back pain symptoms and examining James thoroughly, he asked whether his back had been X-rayed recently. It hadn’t. The doctor thought for a few seconds and, reasonably certain that the problem was muscular in nature, said, ‘Let’s skip the X-rays. Even if we find a slight abnormality, we still won’t know if it is the cause of your back pain.’
This doctor’s decision turned out to be sound. And his thinking makes an important point about many different back pain symptoms diagnosis – namely, what your practitioner sees may have nothing to do with your problem.
Take the case of the fast-food franchise manager who had low back pain for the first time at the age of 45. An X-ray showed that two of his lumbar vertebrae were fused and apparently had been so since birth. The practitioner attributed the pain to this congenital fusion. But the vertebrae had been fused for 45 years without causing back pain.
Furthermore, the patient’s pain vanished in a few weeks while the fused vertebrae, of course, did not. So there’s no way of telling whether the malformation had anything to do with the episodes of back pain.
There are probably millions of people with visible conditions – mild scotiosis, lordosis, some osteoarthritis and congenital mal-formations – who don’t have back pain. There are also millions of people with these problems who do have back pain. And millions of people suffer terribly despite the absence of any obvious back pain symptoms on which to blame the pain. So remember that your spinal curve or malformed vertebra may have nothing to with any given bout of back pain.
Here are some more examples:
A book-keeper with low back pain saw three specialists, two of whom attributed the back pain symptoms to a curvature in her upper back (scoliosis). The third practitioner agreed that there was a curvature but commented, ‘It is ludicrous to think that this mild a curvature could be the major cause of your problem.’ The patient’s treatment and recovery had nothing to do with trying to correct, counter or even consider her spinal curvature.
A farmer was told by one back specialist that his sciatica had been caused by a congenital hip malformation. Another specialist noted the malformation but didn’t think it was congenital or worth worrying about. The farmer recovered by devising his own treatment plan.
A 73-year-old retired hospital administrator was told that an extra lumbar vertebra was causing an unstable back with resultant low back pain. The patient asked her doctor why a structural oddity should suddenly be giving her trouble. There was no answer. There is no answer.
The moral: once you have a diagnosis from your back pain symptoms that rules out serious structural abnormalities, you can probably afford to ignore the little curves and various oddities that practitioners like to point to as maybe, could-be, might-well-be reasons for back pain.