4 Big Reasons Why Back Pain Is Hard to Diagnose

While back pain is exceedingly common, it is equally challenging to diagnose, since there is no established guideline or protocol to evaluate this problem. Besides, the typical setting of a 15-minute doctor’s visit is usually not enough to explain, understand, and evaluate everything that’s going on in your achy back.

Diagnosing the root cause of back pain requires time, physician expertise, and collaboration between different medical professionals, such as primary care doctors, physical therapists, physiatrists, and orthopedic physicians, to name a few.

Below are 4 important reasons why the diagnosis of a back problem may fail or get overly delayed:

1. The specific source of pain can be challenging to identify

The potential underlying causes of back pain are many¹Allegri M, Montella S, Salici F, et al. Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Res. 2016;5:F1000 Faculty Rev-1530. Published 2016 Jun 28. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4926733/:

• Problems may occur within anatomical structures, such as spinal nerve roots, lower back muscles, vertebral bones and joints, intervertebral discs, and/or organs in the abdominal cavity.
• In other cases, your nerves may send abnormal pain signals to your brain, resulting in neuropathic back pain.
• Back pain may also be influenced by psychosocial factors, such as stress, depression, and/or anxiety.

Identifying the exact cause of a back problem may be difficult because of the presence of a combination of problems. For example, a patient may have a herniated disc and spinal stenosis at the same time, and the pain may originate from either of these conditions. But the treatment options vary for both and providing an inaccurate treatment will not help in eliminating the cause of pain.

2. Diagnostic tests have limited value

There are numerous potential issues when it comes to diagnostic tests. But the preeminent problem is that there is no single diagnostic test that can provide an accurate back pain diagnosis. So then, many diagnostic tests have limited value, and some, such as diagnostic nerve block injections may also provide false-positive or false-negative results.²Beynon R, Elwenspoek MMC, Sheppard A, et al. The utility of diagnostic selective nerve root blocks in the management of patients with lumbar radiculopathy: a systematic review. BMJ Open. 2019;9(4):e025790. Published 2019 Apr 20. doi:10.1136/bmjopen-2018-025790 Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6500311/

Of course, this does not mean that your medical professional cannot diagnose your back condition. Certain common conditions, like a lumbar herniated disc that leads to sciatica symptoms, can often be diagnosed quickly and accurately through a variety of clinical tests, questions, and medical imaging scans.

But the inadequacy of any single diagnostic test helps to explain why you may receive different diagnoses from different doctors.

See Introduction to Diagnostic Studies for Back and Neck Pain

3. Pain is a subjective experience and varies widely

Pain is a personal experience for each individual. What may be mild back pain to one person can feel severe and overwhelming to another. Subsequently, the same condition can require completely different kinds and levels of treatment for different people.³Wettstein M, Eich W, Bieber C, Tesarz J. Profiles of Subjective Well-being in Patients with Chronic Back Pain: Contrasting Subjective and Objective Correlates. Pain Medicine. 2018;20(4):668-680. doi:10.1093/pm/pny162 For example, over-the-counter medication and/or exercise may be sufficient to treat the pain from a common back condition for most people. But your subjective experience may dictate that you need a more robust treatment plan to handle your intense pain, such as an epidural steroid injection.

See Types of Back Pain: Acute Pain, Chronic Pain, and Neuropathic Pain

4. Your lifestyle may be a hidden cause

Oftentimes, you may receive an accurate diagnosis and treatment plan, but your back pain may remain the same, recur, or worsen with time. Living a sedentary lifestyle,⁴Hanna F, Daas RN, El-Shareif TJ, Al-Marridi HH, Al-Rojoub ZM, Adegboye OA. The Relationship Between Sedentary Behavior, Back Pain, and Psychosocial Correlates Among University Employees. Front Public Health. 2019;7:80. Published 2019 Apr 9. doi:10.3389/fpubh.2019.00080 Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6465323/ smoking,⁵Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E. The Association between Smoking and Low Back Pain: A Meta-analysis. The American Journal of Medicine. 2010;123(1):87.e7-87.e35. doi:10.1016/j.amjmed.2009.05.028 Available from: https://www.ncbi.nlm.nih.gov/pubmed/20102998 excessive intake of inflammatory foods and/or alcohol, and getting insufficient sleep⁶Sribastav SS, Peiheng H, Jun L, et al. Interplay among pain intensity, sleep disturbance and emotion in patients with non-specific low back pain. PeerJ. 2017;5:e3282. Published 2017 May 16. doi:10.7717/peerj.3282 Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5436560/ may be a few hidden causes. Psychosocial factors, such as stress and anxiety can also cause or add to existing back pain.

See Causes of Lower Back Pain

If you have acute or chronic back pain and do not know the underlying cause, educate yourself on your symptoms and work in partnership with your doctor to formulate a suitable treatment. Also aim to use ergonomically supported postures for your back, get a daily dose of exercise (even if it’s for 10 minutes per day), quit smoking, and eat a nutritious, balanced diet to keep your back healthy.

Learn more:

Chronic Pain Coping Techniques - Pain Management

Specialists Who Treat Back Pain