My 13-year old daughter has started complaining of back pain. It seems to come and go. How can I tell if this is stress, hormonal changes, or something more serious?

The onset of puberty is certainly a possible cause of intermittent low back pain. Both the stress and hormonal changes at this time in a young person's life can lead to back pain. A medical exam is really needed to make a specific diagnosis.

The doctor will take a history and perform certain tests and measures of motion, strength, and neurologic function. The patient's signs and symptoms combined with the exam findings often point to the exact cause of the problem. The correct treatment can't be applied until this happens.

In some cases, blood tests are needed to rule out infection or leukemia. The doctor may think an X-ray is needed. Doctors are careful to avoid unnecessary radiation exposure and expense so these tests are not ordered routinely.

If the X-ray is negative, then an MRI may be needed. MRIs have replaced bone scans as a better way to identify problems in the spine.

A wait-and-see approach is often used for symptoms that come and go and have no known cause. Over time the symptoms may get better on their own. If a disease process is present, eventually the patient will get worse. Medical follow-up from the start of symptoms (a baseline) helps identify important changes that could lead to a diagnosis.