How doctors get to the root cause of your back pain and determine what the best treatment for you may be.

If you go to your doctor seeking help for lower back pain, the first thing he or she will likely do is to ask about your medical history. In addition, information about where you live, the type of work you do, and the hobbies and pastimes you enjoy can help build a picture of how your back pain began. Your doctor will also want to know what self-care measures you have taken to treat the pain yourself, how it has affected your daily life, and what seems to help make it better.

A thorough physical examination will usually follow. This helps to determine the exact location of the pain and what kind of pain it is — sharp or widespread, limited to the back or also affecting the legs. All these factors will help your doctor in making the right diagnosis.

Your age may also play a role in the diagnosis of your lower back pain. Research published recently in the Scandinavian Journal of Work, Environment & Health found that the risks of lower back pain differed between age groups. While those over 50 were more likely to have lower back pain as a result of lifestyle factors such as smoking, obesity, and inactivity, those under 50 were more likely to have an injury related to physical stress at work, and those 40 to 49 were more likely to suffer back pain as a result of mental stress or sleep problems.

Doctors will look at what other symptoms you have in addition to back pain in order to make a diagnosis. "We want to distinguish back pain with and without a specific cause," explains Stephen Hau Yan Kwok, FRCS (Orthopedic), honorary clinical assistant professor in the Department of Orthopedics and Traumatology, Li Ka Shing Faculty of Medicine at the University of Hong Kong.

Five Physical Signs of Back Pain

"There are a series of physical signs that represent a serious cause, and there are different causes that we want to rule out," Dr. Kwok says.

1. Tumor.
"The first would be a tumor, with associated symptoms apart from back pain, such as general malaise [just plain feeling bad], weight loss, and, for gynecological cancers, vaginal bleeding, for example.”
2. Inflammation.
The second thing doctors would look for is back pain with an inflammatory cause. “It would present with symptoms that come and go, are different at various times of the day, and are associated with pain in some other areas, such as the fingers, hips, and upper limbs," Kwok explains.
3. Infection.
"Then there is back pain associated with infection, where we would also see symptoms like night sweats, changes in appetite, fever and chills,” Kwok continues.
4. Trauma.
"The fourth cause is severe trauma, from an accident or injury.”
5. Numbness and weakness.
And fifth is the consequences of severe back pain complications, such as numbness, weakness, and other severe symptoms."

Diagnostic Tests for Lower Back Pain

If a physical examination and medical history don't clearly point to the cause of lower back pain, your physician has a range of diagnostic tests that can help. These include:

• X-rays to pick up problems with the bones and detect arthritis.
• Computed tomography (CT), a diagnostic tool that provides views of internal body structures using X-rays.
• Magnetic resonance imagery (MRI), a special radiology technique designed to image internal structures of the body to reveal problems with soft tissues, blood vessels, and bones.
• Bone scans, a technique that uses a small amount of radioactive material to create images of bones on a computer screen or on film — rarely used but able to detect bone tumors and compression fractures linked to osteoporosis.
• Nerve blocks, an injected anesthetic or numbing agent directly near a nerve to block pain, which can help doctors figure out where the pain is coming from.

Diagnosing Lower Back Pain: The Mind-Body Connection

Not all doctors consider lower back pain to have a purely physical cause. Along with gastrointestinal symptoms, lower back pain has been described as a psychosomatic illness, most notably by John E. Sarno, MD, professor of clinical rehabilitation medicine at New York University School of Medicine in New York City and author of classic books on the subject: Mind Over Back Pain and Healing Back Pain: The Mind-Body Connection. Psychosomatic refers to physical symptoms caused or influenced by feelings or thoughts.

Dr. Sarno coined the term "tension myositis syndrome" to describe lower back pain as a distraction from deep emotional issues which, once recognized as such, often cease to be an issue in back pain. Sarno claims his methods, which prominently feature an informational lecture, have successfully treated more than 10,000 patients.

The point to note here is that no matter what the root of your back pain symptoms, help is at hand. Talk to your doctor about your specific symptoms and what is causing your back pain. Together, you can work toward a plan that is best for your individual circumstances.