How does a doctor diagnose back pain?

Back pain is incredibly common. The overall prevalence of such pain is that 80% of people are expected to have severe symptomatic back or leg pain during their lifetime.

In the vast majority of individuals, this pain settles spontaneously in weeks to months after it’s onset. Reassuringly, however, back pain does spontaneously improve in the vast majority of people. But what can you do during a flare-up of back pain?

Leading orthopaedic surgeon Mr Dimpu Bhagawati offers his advice...

What will my doctor take into consideration when diagnosing my back pain?

To rule out any more serious, underlying pathologies, your GP will discuss whether you have any of the following symptoms when assessing your back pain:
 

• History of cancer
• Unexpected weight loss
• Severe pain when supine or at night
• History of trauma, perhaps from an injury
• Recent bacterial infection or fever
• Immunosuppression (HIV) infection on corticosteroids
• Bladder dysfunction, such as urinary retention or incontinence
• Bowel disruption or incontinence

Your doctor will want to know if you have had persistent symptoms for over four weeks with worsening pain.

These symptoms, however, are relatively uncommon and it is estimated that around two in 100 people will suffer from significant pathologies as listed above when presenting with back pain. For example, a condition such as cauda equina syndrome often presents with fairly low-grade bowel or bladder dysfunction on the background of back pain.
 

How is back pain treated at home?

The conservative (nonsurgical) treatment options for back pain include:
 

• Simply analgesia – Paracetamol or non-steroidal medications
• Activity medication – Yoga or Pilates
• Physiotherapy – conventional physiotherapy, or a chiropractor or osteopathy 

If the pain persists and is causing severe disability, it may require onward referral to a specialist such as a neurosurgeon or an orthopaedic surgeon.
 

What are the common conditions that cause back pain?

The two common conditions that I see regularly in my clinic are:
 

Sciatica (or radiculopathy)

Sciatica involves the pain being referred down the leg by compression of the nerve or in the back. This can also be associated with numbness and motor weakness, such as foot drop. The vast majority settle within six to eight weeks. If there are any signs of bowel or bladder dysfunction, you should be referred for urgent scanning.
 

Spinal stenosis

This commonly affects elderly people. It often manifests with little in the way of physical signs but has a characteristic history. It presents with a cramping feeling within the legs when you walk a certain distance and you might have to stop to relieve the pain. Progressively, over time, walking distance can be decreased. It can occur in relatively active people who enjoy long active walks.

Treatment involves releasing the pressure on the nerves within the back, which can give almost instantaneous pain relief. Again, if there are concerns about bowel or bladder dysfunction, you should be referred for urgent scanning.
 

When would I need to be referred to a specialist?

In cases of sciatica, you should be referred for secondary care if it has been persistent for six to eight weeks. Prior to seeing a specialist, you should have undergone physiotherapy and taken analgesia.

For those who suffer from spinal stenosis, you should see a specialist if the symptoms are restricting your daily activity. Typically, analgesia and physiotherapy are ineffective in this condition and therefore if the symptoms persist, they should be referred for secondary care.



If you would like to discuss your back pain with Mr Bhagawati, you can book an appointment to see him via his Top Doctor’s profile here. Can’t visit him in person? Mr Bhagawati is also available for video call using our e-Consultation tool, which is also found on his profile.