Why Is It So Difficult to Diagnose the Cost of Low Back Pain?

Doctors have a very hard time telling a person specifically why their back hurts. In the US every year back pain affects millions of individuals, with the total cost of care exceeding $100 billion annually.

Even the best trained doctors who see patients with pain in the back on a regular basis including pain management doctors, spinal surgeons, chiropractors and others can only tell a person approximately 50% of the time effectively why their back hurts. The reason is fairly simple. Modern medicine in the realm of back pain is simply not advanced diagnostically nearly as well as in other fields of medicine.

Here are two examples. If you have chronic low back pain and go in for treatment, one of the first things that will be done is plain x-rays. These will be less than 2% effective for actually showing any reason for the pain as even if arthritis is seen, it is not definitively the reason for the pain. There is very poor correlation between the severity of degenerative arthritis seen on x-rays and the amount of pain a person is experiencing.

One study that is very helpful in some respects is MRI when a person has sciatica going down one leg, MRI can be very helpful at showing where the disc herniation is pushing on the nerve root causing a pinched nerve it. However, if one is simply dealing with chronic low back pain but not sciatica, an MRI is not overly helpful.

It will show if one of the disc spaces is degenerated considerably, and it will show up as a dark area as opposed to normal whiteness because water is being lost which shows up dark. Same as with x-rays though, the problem is that a degenerative disc seen on an MRI does not necessarily correlate with why the patient is having back pain.

There were a few studies done years ago showing that in individuals with no pain in the back at all, 40% of them over the age of 40 had considerable degenerative disc disease on MRI.

Another study that is commonly performed when patients have low back pain is called a discography. When a person has failed considerable conservative pain treatment and back surgery is being contemplated then a discogram can help establish whether not the disc is the source of the pain. Interestingly enough, it's also very debatable as to how much the test truly shows whether or not surgery will be helpful. There are research studies on both sides of the fence for lumbar discogram.

One diagnostic test that has been extremely helpful for the workup of low back pain is medial branch blocks. These are injections of numbing medicine that are placed around the facet joints, which are the spinal joints in the back. These injections have shown excellent diagnostic accuracy, meaning if they reduce the patients back pain then it is fairly indicative that the facet joints are the source of the pain.

Working out the source of pain in the low back is difficult at best. Mostly what is happening is the subjective complaints are necessary to know how much a patient is hurting in the low back. It is unfortunate that modern medicine for low back pain had not caught up other areas of medicine. Hopefully the next decade will turn that around.