Your Back Pain Diagnosis Check List!

When you present yourself to you're GP suffering with Back Pain.

Your GP should use various techniques in his or her assessment of the symptom: Back pain. These may include a physical examination or other medical tests. Your doctor may ask several questions when assessing your condition. It is important to remember that your consultation is a two-way process and any extra information you can share with your doctor may help them with their diagnosis.
Some of the questions your doctor may ask are listed below:

1. When did the back pain start?
Why: to determine if acute or chronic.

2. Did the back pain start after any injury or lifting?
Why: helps to determine cause of back pain e.g. dysfunction of intervertebral disc, back muscle strain, compression fracture of the spine, spondylolisthesis.

3. Nature of the pain?
Why: may reveal its likely origin e.g. aching, throbbing pain can indicate inflammation such as spondylitis; deep aching diffuse pain can indicate referred pain such as painful menstruation; superficial steady diffuse pain can indicate local pain such as a muscular strain; boring deep pain can indicate bone disease such as bone tumour or Paget's disease; intense sharp stabbing pain superimposed on a dull ache can indicate sciatica.

4. Where is the back pain worst?
Why: is it central or peripheral, thoracic area or lumbar area.

5. Is your back pain worse when you wake in the morning or later in the day?
Why: Inflammatory pain is worse at night and in early morning; mechanical back pain due to injury is worse at the end of the day and after activity; Continuous pain present day and night is suggestive of infection or bone tumour.

6. Aggravating and relieving factors?
Why: inflammatory back pain causes pain at rest, relieved by activity; mechanical back pain due to injury is exacerbated by activity and relieved by rest; osteoarthritis causes pain with or after activity and relived with rest; pain aggravated by standing or walking and relieved by sitting suggests spondylolisthesis; back pain due to dysmenorrhoea is worse at start of menstrual period.

7. Recent history of gastro-enteritis?
Why: may indicate reactive arthritis.

8. Past history?
Why: osteoarthritis (a common cause of back pain is spondylosis (synonymous with osteoarthritis and degenerative back disease) ankylosing spondylitis, inflammatory bowel disease, psoriasis.

9. Past cancer history?
Why: of cancers that may spread to bones e.g. breast, lung, prostate, thyroid, kidney, bladder, adrenal, melanoma and colorectal.

10. Sexual history?
Why: can determine risk of Reiter's syndrome.


11. Risks of Osteoporosis?
Why: early menopause, premenopausal estrogens deficiency e.g. amenorrhea, cigarettes smoking, high caffeine intake, high alcohol intake, low calcium intake, physical inactivity, chronic corticosteroid use, Cushing's disease, hyperthyroidism, chronic renal failure.

12. Medication?
Why: e.g. warfarin may cause cauda equine compression due to haemorrhage; corticosteroids can lead to osteoporosis.


*Please remember that this is a two-way process!

Terry O'Brien