Diagnostic Services

After an initial history and physical examination, there are various services that can be utilized to help with diagnosing some of the causes of your pain. Some of the techniques used include:

Diagnostic Imaging

Diagnostic imaging is often a critical step in attempting to diagnose the source of a chronic pain condition.

X-rays, or plain radiographs, can be used to evaluate the pathology of the skeletal system. They are not as useful in the imaging of soft tissues such as the brain or muscles.

A CT (computed tomography) scan uses x-ray technology to take multiple cross-sectional views of the inside of the body. Compared to regular x-rays, a CT scan can take clearer images of organs, bone, soft tissue, blood vessels, and other areas of the body.

MRI (magnetic resonance imaging) is a method used by physicians to look inside the human body and obtain anatomical and functional diagnostic information. MR images typically provide greater information about the body’s soft tissue than other techniques.

Frequently Asked Questions about MRI

Diagnostic Injections

It is important to remember that pain is a sensory experience. Pain cannot be imaged with an x-ray or an MRI. These types of imaging studies are helpful in assisting with the diagnosis to the extent that findings correlate with symptoms. Nevertheless, often the key to diagnosing a pain generator is a diagnostic injection. Almost always, these types of injections need to be performed with the assistance of x-ray guidance.

Examples of diagnostic injections include:

     Diagnostic Medial Branch Blocks

Medial branch blocks are very commonly performed diagnostic procedure. Facet Joints are the small joints at the back of the spine.  Facet joints are found in the neck, mid back, and low back.  They are supplied by small nerves called “medial branches.”

Blocking the medial branches that supply facet joints with local anesthetic will block the ability of the medial branches to carry pain information back to the brain.  Therefore, if the pain is due to facet joint arthritis or dysfunction, there should be pain relief that results from performing the blocks. This pain relief should last at least as long as the duration of action of the local anesthetic that is used in the blocks.

If the blocks results in significant pain relief, then a more long-lasting procedure can be performed targeting the medial branches that hopefully would give more long-term pain relief.

     Discogram (Discography)

Discography is performed to answer the question of whether or not back pain or neck pain originates from a disc.

Discography is a diagnostic procedure in which x-ray dye (contrast) is injected into the discs.  After the dye is injected, imaging is performed. The discogram may be normal or may show tears (fissures) in the lining of the disc.

When a normal disc is injected, patients typically  feel a sense of pressure rather than significant pain (although there may be some pain). When an abnormal disc is injected, typically the patient feels significant pain.  If this pain correlates with the patient’s usual pain, the discogram is diagnostic.

     Sacroiliac joint injection

Some injections have the potential to be both diagnostic and therapeutic.  Injection of the sacroiliac joint with local anesthetic and corticosteroid medication is one such injection.

The local anesthetic results in immediate numbness of the joint which helps to confirm the diagnosis of sacroiliac joint pain.

The steroid injected may also reduce the inflammation and/or swelling within the joint.  Decreasing the inflammation may then lead to a reduction of pain.