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Back pain diagnosis and treatment

If you are worried about your back, struggling to cope with the pain, or if you have suffered from regular episodes of back pain for more than 6 weeks, you should contact your doctor or a physiotherapist.

Back pain diagnosis

At your first appointment, the doctor or physiotherapist will discuss your symptoms with you and examine your back.

They will usually assess your ability to sit, stand, walk and lift your legs as well as test the range of movement in your back. To help them diagnose the cause of the pain, they may ask questions about any illnesses or injuries you may have had, your lifestyle and your work. Your back is a complex structure, so finding the exact cause can often be difficult.

Below are some of the questions the doctor or physiotherapist may ask. It might be helpful to consider these before your appointment:

  • When did the back pain start?
  • Where are you feeling pain?
  • Have you had any back problems before?
  • Can you describe the pain?
  • What makes the pain better or worse?

They will first want to make sure your pain is not being caused by a more serious condition. They will ask questions to rule out cancer, a fracture or an infection, although these conditions are uncommon.

If your doctor thinks there may be a more serious cause you will be referred for further tests.

Generally, you won't need an x-ray or an MRI scan because they won't help the diagnosis of your back pain. The Australian Physiotherapy Association (APA) advises x-rays are unnecessary for patients with non-specific low back pain (pain that is not due to a serious back problem).

Back pain treatment

Most cases of back pain don't require medical attention and can be treated with over-the-counter pain relief medication and self-care.

Most people prefer to take paracetamol or anti-inflammatory drugs such as ibuprofen, although research shows these have only a small effect. A stronger pain relief medicine, such as codeine, is an option and is sometimes taken as well as paracetamol.

However, pain relief medicines can have side effects, some can be addictive, and others may not be suitable depending on your state of health. Your doctor or a pharmacist will be able to advise you on the right type of medication to try.

If you also experience muscle spasms in your back, your doctor may recommend a short course of a muscle relaxant.

Injections of medicines that numb the back or reduce swelling may help in a small number of cases.

Physical therapy including exercises and stretches can help. Your doctor, physiotherapist, or chiropractor may teach you these. They may also suggest spinal manipulation which may help lower back pain.

Acupuncture is sometimes used for the treatment of low back pain although it is not certain that it is effective. Some people with back pain also try massage therapy as well as lumbar supports such as cushions or pillows.

Electrotherapy to manage lower back pain is not recommended. This is a form of medical treatment that uses small electrical impulses to repair tissue, stimulate muscles and increase sensations and muscle strength. For further information, visit the Choosing Wisely Australia website.

You will be offered information on what you can do to reduce the effects of your back pain. If the pain lasts for more than 6 weeks, your doctor may refer you to a specialist trained in providing a particular treatment. You may also wish to discuss alternative therapies with your doctor.

Surgery is rarely used to treat back pain.

If you're not happy with your doctor's diagnosis or if your symptoms keep coming back, go back to the doctor or seek a second opinion.

Not sure what to do next?

If you are still concerned about your back pain, why not use healthdirect's online Symptom Checker to get advice on when to seek medical attention.

The Symptom Checker guides you to the next appropriate healthcare steps, whether it’s self-care, talking to a health professional, going to a hospital or calling triple zero (000).

Sources:

NHS Choices (Diagnosis of back pain, Treating back pain)

Last reviewed: July 2015

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Acupuncture and dry-needling for low back pain | Cochrane

Thirty-five RCTs covering 2861 patients were included in this systematic review. There is insufficient evidence to make any recommendations about acupuncture or dry-needling for acute low-back pain. For chronic low-back pain, results show that acupuncture is more effective for pain relief than no treatment or sham treatment, in measurements taken up to three months. The results also show that for chronic low-back pain, acupuncture is more effective for improving function than no treatment, in the short-term. Acupuncture is not more effective than other conventional and "alternative" treatments. When acupuncture is added to other conventional therapies, it relieves pain and improves function better than the conventional therapies alone. However, effects are only small. Dry-needling appears to be a useful adjunct to other therapies for chronic low-back pain.

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Low-back pain is one of the most common and costly musculoskeletal problems in modern society. About 80% of the population will experience low-back pain at some time in their lives. Many people with low-back pain seek the care of a chiropractor. For this review, chiropractic was defined as encompassing a combination of therapies such as spinal manipulation, massage, heat and cold therapies, electrotherapies, the use of mechanical devices, exercise programs, nutritional advice, orthotics, lifestyle modification and patient education. The review did not look at studies where chiropractic was defined as spinal manipulation alone as this has been reviewed elsewhere and is not necessarily reflective of actual clinical practice. Non-specific low-back pain indicates that no specific cause is detectable, such as infection, cancer, osteoporosis, rheumatoid arthritis, fracture, inflammatory process or radicular syndrome (pain, tingling or numbness spreading down the leg).Twelve randomised trials (including 2887 participants) assessing various combinations of chiropractic care for low-back pain were included in this review, but only three of these studies were considered to have a low risk of bias.

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