Difficulties With Diagnosis


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Back pain can be a real tough nut to crack, not only from the person who’s at home, but also from the treating medical practitioner. And the bottom line is, is that back pain doesn’t have to be this confusing array of symptoms and presentations and diagnoses. There’s logic to it, but it requires a little bit of time and a little bit of seeing lots of patients, for instance, when you’re a medical practitioner and you can’t be just a lumper, you have to learn to be a splitter, you have to learn to take a good history. The history with back pain is hugely important. A lot of people will believe that, oh gee, it must be the studies, the MRIs and the CTs. Well, those things are really your confirmatory tests to what your clinical impression is. I will freely admit there’s sometimes when I see patients that, gee, you know, I’m not really sure what the right cause here is and I’ll look to the studies, but the majority of the time you should have a pretty good idea about what’s going on from your clinical history and your exam in terms of what the causes are and then that determines what the treatment is. Unfortunately back pain has become this sort of huge, almost wastebasket or huge net in the ocean that catches lots of different disease processes and different diagnoses. And that’s what makes it both so confusing. But also so vexing because it’s hard I think a lot of times for the patients to really sort out and even from what they’re told by their medical practitioners, what really is the diagnosis here? Why do I hurt? And in many cases we can tell them why, but in some cases we can’t really tell them it’s exactly one thing. We can say, well here are the things we know it isn’t. And you’ve got a pretty clean look and study. So it must be in the muscles, ligaments and tendons. And that’s not always a very satisfying answer for patients because that’s more vague than what they would like.

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