Back Pain Symptoms and Diagnosis
Some diagnoses of all your back pain symptoms are best guesses. They are subject to further diagnostic procedures, or they will be proven or disproved by the passage of time.
Take the case of a journalist who gritted her teeth and put up with many years of back pain until the symptoms finally overcame her. On the basis of X-rays and a clinical examination, an orthopedic surgeon told her she had a ruptured disc requiring surgery. (In fact X-rays are usually ineffective in diagnosing a ruptured disc because the discs themselves cannot be seen on conventional X-rays.)
"The diagnosis of my back pain symptoms terrified me," she recalled. "In retrospect, I feel that it amounted to a misdiagnosis, since I got well without surgery."
Whether the diagnosis was incorrect will never be known. What is known, though, is that it was a tentative diagnosis. The back pain symptoms in the journalist’s legs could have been caused by any one of numerous conditions.
Another back pain sufferer, a businessman, had the wits scared out of him by five diagnoses, none of which was based on concrete evidence: ruptured disc, spinal tumor, compressed nerve in low back, deteriorated disc, and Wilson’s Disease (a serious and rare neurological disorder) – all from the exact same set of back pain symptoms.
There is nothing intrinsically wrong with tentative diagnoses. They can simply indicate that your first visit, which usually consists of history-taking, direct examination and X-rays, signals the need for further diagnostic procedures.
So don’t panic needlessly about think-aloud diagnoses when the doctor first hears of your back pain symptoms. They tend to be less accurate than weather forecasts. They can also give you a headache that will make your back pain seem mild in comparison. And they turn diagnosis into a multiple-choice format. "It could be a disc, a facet joint, some arthritis or a pinched nerve – often without regard for the patient’s feelings."
In fact, the way you are told about a tentative diagnosis can be frightening, even debilitating. It is one thing to say, "you may have a ruptured disc, Ms Jones." But it is quite another matter to say, as a handful of doctors in a recent US survey did before solid evidence was in hand, "Have an operation now or you’ll be pleading for help in a few years."
Many practitioners don’t bother telling patients whether diagnoses based on their back pain symptoms are tentative or documented. As a result, the patient may leave the office badly shaken, rather than informed, with a first-hand and unwelcome opportunity to learn about the role of stress in back pain.
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