Differential Diagnosis of Back Pain

Back pain has numerous potential causes and most often includes non-serious soft tissue disorders. However, in some cases a serious medical condition may be the cause. Serious causes include disorders of the bony parts of the spine, disorders of the subdural or epidural spaces, or disorders of the area where the kidneys are. Doctors will test for a differential diagnosis when the exact cause of back pain cannot be determined.

Mechanical Causes

• According to the Cleveland Clinic, there are five different mechanical differential diagnoses for back pain. One of the most common is a fracture (compression or traumatic), which can occur due to trauma or weak spinal vertebrae. Certain alignment disorders, such as scoliosis, kyphosis and spondylolisthesis, can cause back pain. A condition known as spondylosis, a degenerative joint condition, can cause back pain. Back pain can also be idiopathic. Common idiopathic causes include muscle strains and muscle sprains.

Non-Mechanical Causes

• The Cleveland Clinic states that there are five different non-mechanical differential diagnoses for back pain, including malignancy, bone-related Paget's disease, infection, osteochondrosis and inflammatory spondyloarthropathy. A malignancy is a cancerous condition that can affect any structure of the back or the internal organs. According to the Mayo Clinic, bone-related Paget's disease is a condition in which the bone is abnormally broken down and rebuilt. An infection can affect any structure of the back or the internal organs. Osteochondrosis is a disorder in which bone growth is affected. Inflammatory spondyloarthopathy is an inflammatory disease that affects the spine.

Referred Pain

• Certain conditions can cause back pain without actually affecting the back or its structures. The Cleveland Clinic says that there are four different differential diagnoses for referred pain including pelvic diseases, gastrointestinal diseases, aortic aneurysm, and renal disease. A pelvic disease is a disease that affects the pelvic region and its structures. Common pelvic diseases include pelvic inflammatory disease, endometriosis, and prostatitis. Common gastrointestinal diseases include pancreatitis, a penetrating ulcer, and cholecystitis. Common renal diseases include pyelonephritis, kidney stones, and perinephric abscess. According to the Mayo Clinic, an aortic aneurysm is a condition in which the body's largest blood vessel (aorta) has an area that is bulging and weakened.

Considerations

• Certain factors will cause a doctor to seek out a differential diagnosis for back pain. The Cleveland Clinic says that these include advanced age, failure to respond to treatments, history of cancer, pain still persisting after rest, unexplained weight loss, pain lasting for more than four weeks, chronic infection, and a history of using injected drugs.

Diagnosis

• Doctors seeking to make a differential diagnosis for back pain will perform a series of tests. According to the Cleveland Clinic, the doctor will try to determine whether the pain is caused by problems with a nerve root, or whether the back pain is caused by a serious underlying medical condition not related to the spine, but referring pain to the back and spine. Once this has been determined, the doctor will perform a complete physical examination, discuss the patient's symptoms with him, discuss his personal and family medical history, and have all necessary blood and urine tests performed. If this does not supply a diagnosis, the doctor often orders X-rays and other imaging studies to look for visible abnormalities of the structures of the back. If further diagnosis is needed, the doctor may turn to electrodiagnostic techniques to assess how the patient's muscles and nerves are functioning.