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Lt Col Jerman
Low back pain that persists for 12 weeks or more should be evaluated by a provider. Dr. Patel, what can you tell us about the diagnosis of chronic low back pain?

Dr. Patel
Well, Dr. Jerman, in most cases, providers will start by taking a focused medical history, followed by a thorough physical exam to determine the likelihood of an underlying condition that could be causing the back pain. Most people will then be prescribed appropriate treatments, and asked to return for a second examination after a specific period of time. If the treatments have not proven effective, the patient may then undergo some specific tests.

For most people with chronic low back pain, imaging tests are not required. In fact, in 80 to 90 percent of cases, the cause of low back pain will not show up on these tests. Additionally, abnormal findings on MRI, CT scan, and x-ray usually have nothing to do with the back pain. Approximately one in five people between the ages of 20 and 45 that have no back pain at all will have positive findings with these tests.

For these reasons, imaging tests are recommended only when a serious underlying condition is suspected or when a neurologic deficit is present. A neurologic deficit is a problem in nerve, spinal cord, or brain function that affects a specific part of the body, causing things like muscle weakness, numbness, or loss of bladder or bowel control.

Imaging tests that may be used in these rare cases include MRI and CT scans. MRI, which stands for magnetic resonance imaging, is usually preferred and provides good images of soft tissue. Keep in mind that serious spinal conditions are very rare, occurring in less than two percent of cases.