Tests and Diagnosis

Summary

• The foundation of back pain diagnosis is the history and physical examination — imaging is supplementary
• MRI is indicated when red flags are present or surgery is being considered. Imaging "just in case" can be counterproductive
• In people over 60, the SLR test sensitivity drops to approximately 33% — a negative test does not rule out disc herniation
• Yellow flags (psychological factors) predict the development of chronic pain more accurately than MRI findings
• 37% of chronic low back pain includes a neuropathic component — the PainDETECT questionnaire can help identify this
• Diagnostic injections are useful but have high false-positive rates — results must be interpreted carefully
• An MRI abnormality does not automatically mean you need surgery — this is perhaps the single most important takeaway