There are special maneuvers that should be performed so that the physician can correctly assess and distinguish the many possible causes of chronic low back pain. Imaging techniques may be necessary if there is tenderness over the spine or the patient's history indicates the possibility of a tumor or infection. Simple X-rays can be very useful in determining such conditions as osteoporosis and spondylolisthesis. Thermography converts measurements of body heat, increased by inflammation or infection, into visual signals that can be photographically recorded. Diskography takes pictures of vertebrae in the spine following the injection of radiopaque chemicals that can withstand radiation and X-rays to identify areas producing pain.
Electrophysiologic studies examine the electrical aspects of body functions.
When no physical reason for the pain can be identified, treatment can be difficult to determine, necessitating a multidisciplinary approach to care. In addition, depression, stress or other psychological dysfunction should be treated at the same time. Long-term opioid therapy may be appropriate for carefully selected patients who can be monitored by their physicians and who can appropriately manage their medication. Walking, swimming or cycling on a stationary bike can provide general conditioning and help strengthen weakened muscles while minimizing the stress on the spine. Therapy is tailored to the patient, with gradual increases in duration.