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==Overview==
==Overview==
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, [[intestine|bowel]] [[incontinence]], [[urinary bladder|bladder]] [[incontinence]], progressive [[weakness]] in [[legs]], [[sleep]] interrupted due to severe [[back]] [[pain]], [[fever]], unexplained [[weight loss]].


==History==
==History==
Back pain can be a sign of a serious medical problem, although this is not most frequently the underlying cause:
*Important history question for [[patients]] presenting with [[back]] [[pain]] should include:<ref name="pmid30336508">{{cite journal| author=Chenot JF| title=[Low back pain: focused history taking and physical examination]. | journal=Dtsch Med Wochenschr | year= 2018 | volume= 143 | issue= 21 | pages= 1556-1563 | pmid=30336508 | doi=10.1055/a-0634-8084 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30336508  }} </ref><ref name="pmid27723170">{{cite journal| author=Maas ET, Juch JN, Ostelo RW, Groeneweg JG, Kallewaard JW, Koes BW | display-authors=etal| title=Systematic review of patient history and physical examination to diagnose chronic low back pain originating from the facet joints. | journal=Eur J Pain | year= 2017 | volume= 21 | issue= 3 | pages= 403-414 | pmid=27723170 | doi=10.1002/ejp.963 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27723170  }} </ref>
* Typical warning signs of a potentially life-threatening problem are [[Intestine|bowel]] and/or [[Urinary bladder|bladder]] [[incontinence]] or progressive weakness in the legs. Patients with these symptoms should seek immediate medical care.
**Onset of [[pain]] (sudden or gradual)
* Severe back pain (such as pain that is bad enough to interrupt [[sleep]]) that occurs with other signs of severe illness (''e.g.'' [[fever]], unexplained [[weight loss]]) may also indicate a serious underlying medical condition, such as [[cancer]]. 
**Duration
* Back pain that occurs after a trauma, such as a car accident or fall, should also be promptly evaluated by a medical professional to check for a [[fracture]] or other injury.
**Preceding event
* Back pain in individuals with medical conditions that put them at high risk for a spinal fracture, such as [[osteoporosis]] or [[multiple myeloma]], also warrants prompt medical attention.
**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.


In general, however, back pain does not usually require immediate medical intervention. The vast majority of episodes of back pain are self-limiting and non-progressive. Most back pain syndromes are due to [[inflammation]], especially in the acute phase, which typically lasts for two weeks to three months.
==Symptoms==
 
*It is important to understand that back pain is a [[symptom]] of a [[medical condition]], not a [[diagnosis]] itself.<ref name="pmid27408698">{{cite journal| author=Allegri M, Montella S, Salici F, Valente A, Marchesini M, Compagnone C | display-authors=etal| title=Mechanisms of low back pain: a guide for diagnosis and therapy. | journal=F1000Res | year= 2016 | volume= 5 | issue= | pages= | pmid=27408698 | doi=10.12688/f1000research.8105.2 | pmc=4926733 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27408698  }} </ref>
A few observational studies suggest that two common diagnoses of back pain, lumbar disc herniation or [[degenerative disc disease]] may not be more prevalent among those in pain than among the general population and that the mechanisms by which these conditions might cause pain are not known.<ref>{{cite journal |author=Borenstein DG, O'Mara JW, Boden SD, ''et al'' |title=The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects : a seven-year follow-up study |journal=The Journal of bone and joint surgery. American volume |volume=83-A |issue=9 |pages=1306-11 |year=2001 |pmid=11568190 |doi=}}</ref><ref>{{cite journal |author=Savage RA, Whitehouse GH, Roberts N |title=The relationship between the magnetic resonance imaging appearance of the lumbar spine and low back pain, age and occupation in males |journal=European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society |volume=6 |issue=2 |pages=106-14 |year=1997 |pmid=9209878 |doi=}}</ref><ref>{{cite journal |author=Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS |title=Magnetic resonance imaging of the lumbar spine in people without back pain |journal=N. Engl. J. Med. |volume=331 |issue=2 |pages=69-73 |year=1994 |pmid=8208267 |url = http://content.nejm.org/cgi/content/abstract/331/2/69}}</ref><ref>{{cite journal |author=Kleinstück F, Dvorak J, Mannion AF |title=Are "structural abnormalities" on magnetic resonance imaging a contraindication to the successful conservative treatment of chronic nonspecific low back pain? |journal=Spine |volume=31 |issue=19 |pages=2250-7 |year=2006 |pmid=16946663 |doi=10.1097/01.brs.0000232802.95773.89}}</ref>  Other studies suggest that for as many as 85% of cases, no physiological cause for the pain has been able to be specifically identified.<ref>{{cite journal |author=White AA, Gordon SL |title=Synopsis: workshop on idiopathic low-back pain |journal=Spine |volume=7 |issue=2 |pages=141-9 |year=1982 |pmid=6211779 |doi=}}</ref><ref>{{cite journal |author=van den Bosch MA, Hollingworth W, Kinmonth AL, Dixon AK |title=Evidence against the use of lumbar spine radiography for low back pain |journal=Clinical radiology |volume=59 |issue=1 |pages=69-76 |year=2004 |pmid=14697378 |doi=}}</ref> 
*[[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]]).
A few studies suggest that psychosocial factors such as on-the-job stress and dysfunctional family relationships may  correlate more closely with back pain than structural abnormalities revealed in x-rays and other medical imaging scans.<ref>{{cite journal |author=Burton AK, Tillotson KM, Main CJ, Hollis S |title=Psychosocial predictors of outcome in acute and subchronic low back trouble |journal=Spine |volume=20 |issue=6 |pages=722-8 |year=1995 |pmid=7604349 |doi=}}</ref><ref>{{cite journal |author=Carragee EJ, Alamin TF, Miller JL, Carragee JM |title=Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain |journal=The spine journal : official journal of the North American Spine Society |volume=5 |issue=1 |pages=24-35 |year=2005 |pmid=15653082 |doi=10.1016/j.spinee.2004.05.250}}</ref><ref>{{cite journal |author=Hurwitz EL, Morgenstern H, Yu F |title=Cross-sectional and longitudinal associations of low-back pain and related disability with psychological distress among patients enrolled in the UCLA Low-Back Pain Study |journal=Journal of clinical epidemiology |volume=56 |issue=5 |pages=463-71 |year=2003 |pmid=12812821 |doi=}}</ref><ref>{{cite journal |author=Dionne CE |title=Psychological distress confirmed as predictor of long-term back-related functional limitations in primary care settings |journal=Journal of clinical epidemiology |volume=58 |issue=7 |pages=714-8 |year=2005 |pmid=15939223 |doi=10.1016/j.jclinepi.2004.12.005}}</ref>
*In few cases [[back]] [[pain]] can be a [[symptom]] of a serious [[medical]] condition. [[Symptoms]] to look for include:<ref name="pmid31899561">{{cite journal| author=Welk B, Baverstock R| title=Is there a link between back pain and urinary symptoms? | journal=Neurourol Urodyn | year= 2020 | volume= 39 | issue= 2 | pages= 523-532 | pmid=31899561 | doi=10.1002/nau.24269 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=31899561  }} </ref><ref name="pmid25790449">{{cite journal| author=Lumley MA, Schubiner H, Carty JN, Ziadni MS| title=Beyond traumatic events and chronic low back pain: assessment and treatment implications of avoided emotional experiences. | journal=Pain | year= 2015 | volume= 156 | issue= 4 | pages= 565-566 | pmid=25790449 | doi=10.1097/j.pain.0000000000000098 | pmc=4369787 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25790449  }} </ref><ref name="pmid8434327">{{cite journal| author=Polatin PB, Kinney RK, Gatchel RJ, Lillo E, Mayer TG| title=Psychiatric illness and chronic low-back pain. The mind and the spine--which goes first? | journal=Spine (Phila Pa 1976) | year= 1993 | volume= 18 | issue= 1 | pages= 66-71 | pmid=8434327 | doi=10.1097/00007632-199301000-00011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8434327  }} </ref><ref name="pmid25125938">{{cite journal| author=Mabry LM, Ross MD, Tonarelli JM| title=Metastatic cancer mimicking mechanical low back pain: a case report. | journal=J Man Manip Ther | year= 2014 | volume= 22 | issue= 3 | pages= 162-9 | pmid=25125938 | doi=10.1179/2042618613Y.0000000056 | pmc=4101555 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25125938  }} </ref>
**[[Intestine|Bowel]] [[incontinence]]
**[[Drug abuse]]
**[[Urinary bladder|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]])


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 21:58, 29 May 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S[2]

Overview

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.

History

  • 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.

Symptoms

References

  1. ↑ Chenot JF (2018). "[Low back pain: focused history taking and physical examination]". Dtsch Med Wochenschr. 143 (21): 1556–1563. doi:10.1055/a-0634-8084. PMID 30336508.
  2. ↑ Maas ET, Juch JN, Ostelo RW, Groeneweg JG, Kallewaard JW, Koes BW; et al. (2017). "Systematic review of patient history and physical examination to diagnose chronic low back pain originating from the facet joints". Eur J Pain. 21 (3): 403–414. doi:10.1002/ejp.963. PMID 27723170.
  3. ↑ Allegri M, Montella S, Salici F, Valente A, Marchesini M, Compagnone C; et al. (2016). "Mechanisms of low back pain: a guide for diagnosis and therapy". F1000Res. 5. doi:10.12688/f1000research.8105.2. PMC 4926733. PMID 27408698.
  4. ↑ Welk B, Baverstock R (2020). "Is there a link between back pain and urinary symptoms?". Neurourol Urodyn. 39 (2): 523–532. doi:10.1002/nau.24269. PMID 31899561.
  5. ↑ Lumley MA, Schubiner H, Carty JN, Ziadni MS (2015). "Beyond traumatic events and chronic low back pain: assessment and treatment implications of avoided emotional experiences". Pain. 156 (4): 565–566. doi:10.1097/j.pain.0000000000000098. PMC 4369787. PMID 25790449.
  6. ↑ Polatin PB, Kinney RK, Gatchel RJ, Lillo E, Mayer TG (1993). "Psychiatric illness and chronic low-back pain. The mind and the spine--which goes first?". Spine (Phila Pa 1976). 18 (1): 66–71. doi:10.1097/00007632-199301000-00011. PMID 8434327.
  7. ↑ Mabry LM, Ross MD, Tonarelli JM (2014). "Metastatic cancer mimicking mechanical low back pain: a case report". J Man Manip Ther. 22 (3): 162–9. doi:10.1179/2042618613Y.0000000056. PMC 4101555. PMID 25125938.

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