The power of the visible: the meaning of diagnostic tests in chronic back pain

This article explores the meaning of diagnostic tests for people with chron ic back pain, Lower back pain is one of the most common health problems in the US. Five to ten percent of the patients who visit a primary care provid er for back pain ultimately develop a chronic condition. We draw on intervi ews with chronic back pain patients in Atlanta, Dallas and Seattle to argue that testing constitutes an important element in the legitimation of pain for these patients. We discuss three aspects that make testing an area of c oncern for patients: a strong historical connection between visual images a nd the medicalization of the interior of the body, a set of cultural assump tions that make seeing into the body central to confirming and normalizing patients' symptoms, and the concreteness of diagnostic images themselves. O ur interviews show that when physicians cannot locate the problem or expres s doubt about the possibility of a solution, patients feel that their pain is disconfirmed. Faced with the disjunction between the cultural model of t he visible body and the private experience of pain, patients are alienated not only from individual physicians but from an important aspect of the sym bolic world of medicine. This paper concludes by suggesting that a fluid, l ess localized understanding of pain could provide a greater sense of legiti macy for back pain patients. (C) 1999 Published by Elsevier Science Ltd. Al l rights reserved.