by Alan Jordan
When interviewing patients with longstanding lower back pain one of the areas that we must focus on is the nature of the patient’s pain, how it “feels”, what if anything relieves it, what worsens it, where exactly is it, what activities are limited and so forth. Determining whether a patient is in fact experiencing back pain due to Modic changes requires 3 pieces of a puzzle to arrive at the proper diagnosis.
These include;
- A characteristic case history particularly as regarding the pain description and activity limitations
- Characteristic physical findings found during the physical examination
- An MRI scan that confirms the diagnosis
Pain and Limitations
The Spine Centre at the University of Southern Denmark as devised 9 questions that are of particular relevance to identifying patients that might be suffering from lower back pain due to Modic changes.
They are;
If your response is YES to three or more of these questions, it is possible that you have Modic changes in your spine. We advise you to contact a Certified MAST doctor or therapist who will provide you with the proper treatment
1. Do you have pain in your lower back during the night?
2. Does the pain in you lower back wake you up when you turn over in bed?
3. Is the pain worse in the morning, better at noon and worse again in the afternoon and evening?
4. Does it feel as though your pain is located deep in your spine?
5. Does the pain sometimes radiate down to one or both of your legs?
6. When doing physical activity or exercising, does your back pain get worse or at best remain unchanged?
7. Have you ever had an X-ray that shows you have some spinal disc degeneration?
8. Do you suffer back pain constantly or for most of the day? Even if the intensity varies so that at some point it is relatively low, do you still find it difficult to ignore the pain?
9. Have you tried a variety of treatments that normally help back pain but they didn’t work for you?
As mentioned above the case history is only 1 – but an important part – of the 3 part puzzle that clinicians need accurate answers for prior to initiating long term antibiotic treatment for Modic changes. From personal experience I would emphasise that in addition to night pain, and exercise intolerance (the opposite of “normal” back pain patients, Modic patients almost always say that they ALWAYS have pain.
This article has dealt with case history highlights related to lower back patients with Modic changes.
Dr Alan Jordan Chiropractor Phd
