What's causing your aching back? These tests can help your doctor make the right diagnosis and speed your way toward relief.

Next to headaches, back pain is the most common neurological problem experienced in the United States. Medications such as anti-inflammatory drugs and physical therapy sessions help many people get relief from their back pain, but some need more help and turn to a specialist.

"We treat patients who need more than physical therapy and medications," says Santiago Figuereo, MD, neurological surgeon and founder and medical director of the Miami Neurological Institute.

Relief from back pain symptoms starts with getting the correct diagnosis. Your doctor will begin by taking a complete history of your back pain symptoms before moving on to possible back pain causes, such as a damaged disk or a pinched nerve.

Preparing for Your First Office Visit

Your first appointment will include a physical exam, but one of the most important clues needed to determine your back pain causes comes from sharing a thorough history of your back pain symptoms with your doctor. Bring a detailed list of those symptoms with you and also be prepared to answer these questions:

• How long have you had the back pain?
• Is the pain just in your back or does it radiate into your leg or arm?
• What makes the pain better?
• What makes the pain worse?
• Have you been treated for back pain previously?
• Was treatment helpful?

Your doctor will probably ask about other symptoms that could be related to problems with the spine, Dr. Figuereo says. These questions may include:

• Do you ever feel weakness, numbness, or tingling?
• Do you ever experience urinary incontinence or urinary retention (trouble urinating)?

"Those are red flag symptoms that worry us for serious trouble of the spine," Figuereo says.

Tests to Determine Back Pain Causes

Your doctor will perform a physical exam and order a number of tests to try to localize the cause of your back pain. Tests your doctor may order include:

• MRI. Magnetic resonance imaging (MRI) uses a magnetic field and radio frequency to create a picture of bones, soft tissues, and organs. It gives your doctor a picture of your spinal cord, the nerves, and the discs of the spine, which are the most commonly affected structures in cases of back pain. With an MRI, your doctor can see if there's serious damage to a disk or a pinched nerve, says Figuereo. But using an MRI scan is somewhat controversial, since some experts believe they often show abnormalities that aren't related to pain.
• X-rays. X-rays of the lumbar spine will reveal if there's damage to bones from a fall or trauma. However, X-rays aren't helpful for routine back pain that isn't a result of trauma, Figuereo says.
• CT scan. CT scans (or CAT scans) are more detailed X-rays that give a better picture of the anatomy of the bones, Figuereo says. They're used to rule out major problems, but aren't the most effective test, he adds.

Most of the time, people with new back pain symptoms will see an improvement down the road, Figuereo says. When this doesn't happen, doctors can investigate further to get an idea of your back pain causes.