Back & Neck / By Ioannis Avramis, MD / March 1, 2022
Back pain. It’s an all too familiar story. You wake up on the weekend with a whole day of activities planned and you notice a small soreness or ache in your lower back. You can’t think of anything you did over the last couple days that would have caused this pain, but you shrug it off. Throughout the day, as you try to go through your activities, the back pain becomes more and more significant until finally, you decide you need to sit down and rest.
Lower back pain is something that we all experience at some point in our lives. Thankfully, with rest, time and some over-the-counter medications, the pain will usually subside. But what if it doesn’t? Unfortunately, some people have persistent back pain that can be progressive and associated with other symptoms such as sciatica, numbness or pain in the legs.
Most people who are experiencing back pain for more than a couple weeks, particularly if there is associated sciatica with it, will get evaluated by their primary care doctor and get a referral to see a spine surgeon. As with most medical conditions, navigating the terminology around back pain and sciatica can be confusing for the patient.
That’s why I’m here. Hopefully, having a spine surgeon’s perspective can equip you to have a more meaningful and effective conversation with your own spine surgeon. Here’s what to say and how to describe your back pain when you go for a doctor’s visit.
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Questions you’ll answer about your back pain
Often, the most helpful source of information is the history provided by the patient.
When talking to your spine surgeon about your low back pain, generally, you will be asked to describe your symptoms followed by very specific questions. Be prepared to talk about these aspects of your back pain:
- Where is the pain located?
- Where does the pain radiate to?
- What exacerbates or improves the pain?
- How long has the pain been present?
- Is the pain getting any better or worse?
- Can you think of any inciting incident that may have caused the pain to start?
- Is the pain sharp, dull, burning, aching and/or sudden? These are common descriptors used regarding back pain.
- Are you experiencing any leg numbness, tingling, pain, weakness, heaviness and or clumsiness?
- How does the pain react to sitting, standing and walking? How does the pain affect the way you walk?
With all this information, a spine surgeon should have a reasonable idea whether this is a muscular strain of the low back, an acute disc herniation, degenerative lumbar stenosis, spinal instability or other less common issues.
Next, you’ll discuss any prior treatments such as over-the-counter medication, prescription medication, physical therapy, spinal injections and spinal surgery. The prior treatments that have been carried out—and most importantly, your response to them—help dictate the next step in a treatment plan.
How we get to a back pain diagnosis
As your spine surgeon is gathering this information about your back pain, they are formulating a list of possible causes.
For example, mild, improving, isolated low back pain that has been present for two weeks and is slowly improving with rest could be a simple muscular strain. On the other hand, severe, worsening low back pain associated with severe leg pain and numbness that the patient has never felt before could represent an acute disc herniation.
For a spine surgeon to arrive at a clear diagnosis, we must take into consideration your history, the physical examination findings and any spinal imaging available. When all three of these sources of information point to the same diagnosis, we can be confident we have a correct diagnosis and move forward with the right treatment plan.
Obviously, some patients can have a much more complex history, which will require more in-depth questions and evaluation. However, the information you provide about your back pain will help narrow down the different possible diagnoses and help your doctor get to the right one.
Hopefully you’re feeling better prepared to talk about your back pain with your doctor. If you’re looking for a doctor to help relieve your pain, find spine care near you today.
About the author
Ioannis Avramis, MD
Ioannis Avramis, MD, is an orthopedic spine surgeon on the medical staff at Baylor University Medical Center. Book an appointment with Dr. Avramis today.
