Working with your doctor

Your doctor needs a complete picture of you and your back pain before he or she can get to the bottom of the problem. During the telling of your story and a physical examination, any one fact may be the clue that solves the puzzle of your back pain. In fact, most diagnoses are established during the history portion of the examination. The rest of the process identifies the correct diagnosis from the variety of possibilities developed by your description of your back pain.

Your age and gender, naturally, are important to a correct diagnosis. For example, more herniated discs occur between the ages of 25 and 45. Conversely, approximately 80 percent of people with cancer of the spine are fifty or older. Men have back pain more frequently than women, some of which may be explained by occupational exposure to more physically strenuous work. Certain disorders occur exclusively or predominantly in women, such as back pain during pregnancy and osteoporosis. (Men are at risk for this thinning of the bones, too, but the risk is greater for postmenopausal women.)

The history you provide is the most important part of the diagnostic process. The more complete the information, the greater its value. Every subsequent step is used to confirm the ideas and even hunches developed during the medical history. The first part of your history, the chief complaint, is your description of what brought you to the doctor. In most circumstances, the chief complaint is "I have a pain in my back." Another frequent chief complaint is "I have a pain in my back that runs down my leg to my foot." Your description guides the doctor's questions.

Telling your story allows you to describe those events that you believe are most important in explaining the evolution of your back pain. Your doctor may or may not ask questions as you progress with your narrative. A physician may interrupt to ask a question if a particular point is essential to differentiate between diagnostic possibilities. For example, you may be asked: "Did the pain that ran down your leg go to your big toe or small toe?"

Help yourself and your doctor by gathering your thoughts about your back pain and organizing the description of your symptoms and questions you want to ask. Perhaps you can store the information in your head, but writing it down may be more useful. By carefully thinking about your back pain, you will have organized information necessary to start the diagnostic process. Also, bring a list of your medicines—or the actual medicines—with you and the names and addresses of your other healthcare providers.