What should you do, if the pain did not settle down after 4-6 weeks?

If the pain is still dominant, although you got more than 10 treatments of injections, infusions, physical therapies or analgetic medication, your physician will order more diagnostic procedures to find out the cause. These procedures could be a lab testing, X-ray, magnetic resonance imaging (MRI) or the computertomography (CT). 
Maybe you wander why your physician did not order these diagnostic method quite at the beginning - the international diagnostic algorithm recommends to start with a thorough history and investigation, because this up to now has the best validity to approach the "true " diagnosis. One should know that all diagnostic procedures have a very bad correlation to the complaints - so some people have terrible x-rays or MRIs and feel totally fine, while others show perfect MRIs and X-rays, but cry from pain.

A very clever collegue in Seattle, Prof. Deyo, once said: "All these degenerative findings in the X-ray are normal signs of getting older, like wrinkles in the face or grey hair and should not automatically be assessed as pathological!"  

So, the interational community came to the conclusion that with a >90% certainty we can fix the diagnosis by thorough asking and investigating the patient. The a.m. diagnostic tools should be just used, to exclude or confirm a diagnosis, the physician found out by history and investigation before!

Nevertheless, if a pain cannot be solved up after adequate therapy and no additional findings came up e.g. in the MRI, the physician should think over it, to send the patient to a more specialised institution - because about 5-10% of the backpain patients develop a chronic pain disease, which has to be approached and treated very different than the "every-day-backpain". 
 


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