In most cases, back pain not involving neurological symptoms will disappear without the need for medical care. Although it may take weeks for the pain to completely resolve, improvement should be evident within 72 hours. If not, patients should seek the care of a physician.

Patients should see their physician immediately if they are age 50 or older, or if they have a history of back pain or cancer. They should also see a physician promptly if back pain:

• Feels constant or intense, particularly at night
• Spreads down one or both legs
• Causes weakness, numbness or tingling in one or both legs
• Causes new bowel or bladder problems
• Is associated with abdominal pain or throbbing
• Results from a fall or a blow to the back
• Is associated with fever or unexplained weight loss
• Does not improve when lying on one’s back

In diagnosing back pain, a physician will review the patient’s medical history and perform a physical examination. The physician will try to determine where the pain is located, how it is limiting a patient’s range of motion and whether or not muscle spasms are present. The patient’s muscle strength and ability to sit, stand, walk and lift both legs will be noted. A rubber hammer may be used to test reflexes.

If the physician suspects a tumor, fracture, infection or other disease, additional testing may be required. These tests can include:

• Blood tests and urine tests. Lab tests used in detecting or ruling out a wide range of conditions, from arthritis to sickle cell anemia.
  
  
• X-ray. A painless test in which an image is created of part of the body by using low doses of electromagnetic radiation that are reflected on film or fluorescent screens. Images may show the alignment of bones and whether or not the patient has degenerative joint disease or broken bones. However, these images cannot reveal problems with the spinal cord, muscles, fibrous tissues, nerves or intervertebral discs.
  
  
• MRI (magnetic resonance imaging). A noninvasive or minimally invasive test that uses sound waves and a magnetic field to produce clear cross-sectional or three-dimensional images of the body’s tissues. Images can be used to examine the lumbar region for bone degeneration. MRI can also help diagnose injury or disease in tissues, nerves, muscles, ligaments and blood vessels.

• CAT scan (computed axial tomography). A noninvasive or minimally invasive test that uses multiple x-ray images, taken from different angles, to create three-dimensional images of body structures. Images may reveal disorders such as herniated discs, spinal stenosis or damage to vertebrae.
  
  
• Ultrasound. Uses high-frequency sound waves to create images of internal organs or tissues. It works by sending low-energy sound waves against tissue. It works by sending low-energy sound waves against tissue. Some waves pass through and some bounce back. As sound waves bounce back, they are recorded and displayed on a computer screen or television-type monitor.  Ultrasound can be helpful to rule out the abdominal causes of back pain (e.g., kidney stones).
  
  
• Bone scans. A type of radionuclide imaging test. Images may reveal bone tumors or compression fractures caused by osteoporosis. To perform the procedure, a physician injects a small amount of radioactive substance into the patient’s veins. After the substance has collected in the bones, a special camera is used to detect bone problems highlighted by the substance.
  
  
• Electromyography. Measures electrical impulses generated by nerves and the muscles’ response to those impulses. This information can be used to confirm nerve compression resulting from herniated discs or spinal stenosis.
  
  
• Discography. A special dye is injected into a spinal disc that is thought to be causing back pain. The dye highlights damaged areas that are revealed when x-rays are taken. This procedure is often used on patients who are considering spine surgery or whose pain has not responded to conventional treatments. A variation called functional anesthetic discography (FAD) involves injection of anesthetic into the disc.
  
  
• Spinal tap (lumbar puncture). Insertion of a needle into the spinal canal to extract cerebrospinal fluid for analysis. Spinal tap may be used in diagnosing conditions that can affect the central nervous system, such as Lyme disease or tumors.
  
  
• Injections.  When other tests are inconclusive, injections (e.g., facet joint injections) are sometimes done to diagnose the condition.