Low Back Pain History

Aka: Low Back Pain History

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II. Symptoms: Low Back Pain Timing

  1. Duration
    1. Acute Low Back Pain onset within 3 months
    2. Chronic Low Back Pain persistent beyond 3 months
  2. Follows Trauma, bending, or lifting
    1. Suggests Lumbar Disc Disease
  3. Morning back stiffness with pain and onset before age 40 years
    1. Suggests Spondyloarthropathy
  4. Age of onset
    1. Age under 20 years
      1. Diskitis
      2. Vertebral Metastases
      3. Scoliosis
      4. Pyelonephritis
      5. Sickle Cell Anemia
      6. Slipped Vertebral apophysis
    2. Age under 20 years: Athletes
      1. Spondylolysis (with risk of Spondylolisthesis)
      2. Vertebral Stress Fracture
      3. Hyperlordosis
    3. Age 20 to 50 years old
      1. Lumbar strain or sprain
      2. Lumbar Disc Disease
      3. Lumbar Spinal Stenosis
      4. Spondyloarthropathy
      5. Genitourinary causes (e.g. Pyelonephritis, Nephrolithiasis, Endometriosis, Pelvic Inflammatory Disease)
      6. Gastrointestinal causes (e.g. Cholecystitis, Peptic Ulcer Disease, Pancreatitis)
    4. Age over 50 years
      1. Vertebral Compression Fracture
      2. Spinal stenosis
      3. Spondylosis
      4. Vertebral Metastases
      5. Vertebral Diskitis or Vertebral Osteomyelitis
      6. Abdominal Aortic Aneurysm
      7. Herpes Zoster

III. Symptoms: Low Back Pain Location and Radiation

  1. Dermatomal
    1. Herpes Zoster
  2. Spine
    1. Midline (especially with Vertebral tenderness and limited range of motion suggests )
      1. Vertebral disorder
        1. Traumatic Vertebral Fracture (major Trauma)
        2. Compression Fracture
        3. Vertebral metastases
        4. Vertebral Osteomyelitis
      2. Disc disorder
        1. Herniated Disc
        2. Vertebral diskiitis
    2. Sacroiliac Joint
      1. Sacroiliac Joint Dysfunction
      2. Spondyloarthropathy
    3. Paraspinous or lateral low back
      1. Lumbar strain or lumbar sprain
  3. Abdomen
    1. Epigastrium and upper quadrants radiating to upper portion of the low back
      1. Peptic Ulcer Disease
      2. Pancreatitis
      3. Cholecystitis
      4. Constipation
    2. Unilateral Abdominal Pain radiating to flank
      1. Nephrolithiasis
      2. Pyelonephritis
    3. Periumbilical Abdominal Pain radiating to midline of low back
      1. Abdominal Aortic Aneurysm
  4. Buttock
    1. Piriformis Syndrome
    2. Sacroiliac Joint Dysfunction
    3. Pilonidal Cyst
    4. Perirectal Abscess
  5. Leg
    1. Vertebral levels L1 to L3 radiates to hip and thigh
    2. Vertebral levels L4 to L5 radiate below the knee
      1. Radiation below knee is most specific for Herniated disc

IV. Symptoms: Low Back Pain Provocation

  1. Prolonged sitting provokes pain
    1. Lumbar Disc Disease
    2. Spondylosis (disc pain)
  2. Valsalva (cough, sneeze, or straining) provokes pain
    1. Lumbar Disc Disease
  3. Hyperextension provokes pain
    1. Spondylolisthesis
    2. Spondylolysis
    3. Spondylosis (facet pain)
    4. Sacroiliac Joint Disease
  4. Standing or Walking
    1. Lumbar Spinal Stenosis
      1. Pseudoclaudication with pain radiating into legs
    2. Spondylolisthesis
    3. Spondylosis (facet pain)

V. Symptoms: Low Back Pain Palliation

  1. Rest (relative or complete?)
    1. Lumbar Strain or sprain
  2. Ice or heat?
  3. Medications?
  4. Lying with knees flexed relieves pain
    1. Lumbar Disc Disease
    2. Spondylolisthesis
  5. Sitting relieves pain
    1. Lumbar Spinal Stenosis

VI. References

  1. Arce (2001) Am Fam Physician 64(4):631-8 [PubMed]
  2. Bratton (1999) Am Fam Physician 60(8):2299-306 [PubMed]
  3. Bueff (1996) Prim Care 23:345-64 [PubMed]
  4. Patel (2000) Am Fam Physician 61(6):1779-86 [PubMed]

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