Everyone deserves THE dignity of a diagnosis
Why do some treatments work so well for one patient, yet fail for another?
We often assume the problem is the treatment. But more often, it’s the diagnosis.
When it comes to low back pain, the limitations of history, examination, and imaging make it logical to diagnose “Non-specific” low back pain. It then makes sense to apply broad “Non-specific” therapies such as exercise, rehab and education.
These approaches absolutely help, but unfortunately not for everyone.
To get one person with LBP 30–50% better using these methods, we need to treat 3–5 patients (NNT = 3–5). In other words, only about 20–30% of patients respond well. That’s a success, but it means 70–80% still don’t get better. And when that happens, both patients and clinicians face uncertainty.
That’s when we move from “Non-specific” management to “Specific” diagnosis.
For me, this is where diagnostic blocks come in.
Looking at the main causes of back pain, based on diagnostic block data:
Facet joints: 15–40% (Schwarzer AC, Ann Rheum Dis 1995; Schwarzer AC, Spine 1994)
Sacroiliac joint: 10–20% (Schwarzer AC, Spine 1995; Maigne et al, Spine 1996)
Hip: 5–10% (with 40% of hips referring to the buttock) (Lesher et al, 2015)
Disc: 16–26% (Verrills et al, 2015; Hirsch et al, Pain Physician 2018)
Nerve-related pain: 12–40% (back and radicular symptoms) (Hoy et al, Best Pract Res Clin Rheumatol 2010)
Diagnostic blocks are about taking pain from “Non-specific” to “Specific.”
The technique itself may seem complex, but the process is simple: by temporarily numbing a specific nerve or structure, we learn something vital:
If the pain eases → we’ve likely found the source.
If it doesn’t → we’ve ruled something out.
Either way, guesswork is replaced with clarity.
And once we know the right diagnosis, we can match the right treatment.
Everyone deserves the dignity of a diagnosis. And the ability to give that clarity to patients, shifts something.
Patients stop feeling lost or blamed and start feeling believed. It builds self-efficacy with knowledge of a pathway ahead.
For clinicians, clarity stops feelings of uncertainty and promotes confidence in what you are doing.
It’s not about doing more. It’s about giving the right patient, the right treatment, at the right time.
Clarity isn’t the end of the journey.
It’s where healing starts.
— Dan