Regarding back pain, finding the cause or determining the underlying diagnosis is key. Most people believe that there must be some structural changes in the spine, such as degenerative disorders or an injury that cause the pain. However, structural disorders are not the cause of back pain in some cases. This does not mean no cause can be found, and a thorough check-up can be helpful. This multidisciplinary model of care, known as the biopsychosocial model, aims to tease out the different parts of a person’s condition. Some patients have greater psychological, social and emotional effects with less physical ill-effects from their back pain; other patients have the reverse: pain driven by a structural abnormality in the back. Clinical questionnaires can often identify what aspects of the pain are most relevant.
Radiographic (x-ray) imaging is often unnecessary with acute low back pain, which is self-limiting, but with persistent back pain, the patient will most likely warrant erect radiographs, to analyse spinal alignment. An MRI scan can evaluate the soft tissues such as the discs, muscles, ligaments and fascia. MRI has limitations in that it may highlight abnormalities from wear and tear that may not be attributable to the patient's current pain. Many findings don't have to be considered a problem but are part of normal ageing. Importantly MRI may exclude potential diagnoses that heavily affect a patient's mind, such as cancer. However, risks like this can be identified in other ways, including through a patient's clinical history, considering aspects such as smoking, unexplained weight loss, and personal history of cancer.