Back pain history and symptoms

Important history question for patients presenting with back pain should focus on, pain onset, duration, radiation, aggravating or relieving factors, intensity, preceding event (surgery, intense exercise, trauma), and associated symptoms including, bowel incontinence, bladder incontinence, progressive weakness in legs, sleep interrupted due to severe back pain, fever, unexplained weight loss.

• Important history question for patients presenting with back pain should include:^[1][2]
  • Onset of pain (sudden or gradual)
  • Duration
  • Preceding event
  • Intensity
  • Location
  • Characteristic (dull ache, burning, tearing, sharp)
  • Pain present at rest, during sleep
  • Changes intensity with activity or while sleeping
  • Does the pain radiate elsewhere
  • Associated symptoms
  • Aggravating or relieving factors
• In general, back pain does not usually require immediate medical intervention.
• Mostly cases due to inflammation, especially in the acute phase, which typically lasts for two weeks to three months and resolves on its own without progressing.

• It is important to understand that back pain is a symptom of a medical condition, not a diagnosis itself.^[3]
• Back pain may occur by itself, or along with other symptoms.
• Symptoms include severe low back pain that may be accompanied by muscle spasm, pain with walking, concentration of pain to one side, and no radiculopathy (radiating pain down buttock and leg).
• In few cases back pain can be a symptom of a serious medical condition. Symptoms to look for include:^[4][5][6][7]
  • Bowel incontinence
  • Drug abuse
  • Bladder incontinence
  • Progressive weakness in legs
  • Sleep interrupted due to severe back pain
  • Fever
  • Depression
  • Unexplained weight loss
  • Back pain due to trauma
  • Increased back pain in patients with osteoporosis or multiple myeloma
  • Repetitive intense exercise involving lumbar extension
  • Long term corticosteroid use (can cause fractures)

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