One of the most important components of a new or existing patient evaluation for low back pain is taking a thorough, detailed, patient history. I will describe the most common questions asked and what they may tell about the low back pain. The components include:
- Location – where are the symptoms? (left side, right side, central, etc.). Gives an idea on where the symptoms may be originating in terms of the lumbar region, thoracolumbar region and sacroiliac joints
- Onset date/how long – Allows the symptoms to be classified as acute, subacute or chronic. The length of time the symptoms have been present can influence the time it may take to resolve symptoms.
- Status of the complaint since onset (improving/worsening/staying the same) -Gives information on how the low back symptoms are trending over time.
- Provocative/what makes symptoms worse – Especially helpful for analyzing the positions/movements that patients are performing when their symptoms are worse. For example, a patient may say that their low back pain is worse when sitting. The low back is in a flexed position when sitting; therefore, the patient may benefit from limiting the flexion positions temporarily for symptom relief.
- Palliative/what makes symptoms better – Also helpful for determining the appropriate home exercise prescription. A patient may say their low back pain is better when standing and walking. Standing and walking puts the low back in an extension position. The home exercise prescription for a patient that feels better when standing and walking may be standing back extensions.
- Quality – The descriptions can indicate the structures involved. For example, sharp pain may suggest nerve irritation; whereas, dull, achy pain may suggest joint irritation. Also, numbness and tingling may also suggest nerve irritation.
- Radiation – Are symptoms local or do they spread to the leg, hip, or ankle? Numbness, tingling and pain that spreads from the low back to the ankle may indicate nerve root inflammation also known as radiculitis.
- Severity – The severity of the symptoms can broadly be categorized as mild, moderate or severe. The severity can influence the frequency that treatment should occur to reduce the pain intensity
- Constant/intermittent – Are the symptoms present all the time or do they come and go. If the symptoms come and go it may indicate that a particular position/movement that the patient is doing may be correlated.
- Timing – Are the symptoms better/worse in the morning, afternoon and/or evening. If a patient is worse in the morning, it may have an association with the sleeping position.
- Previous history of the complaint – Has the patient had a similar complaint in the past? Previous history of low back pain increases the risk for future low back pain.
- Previous treatments for the complaint – Has the patient received other treatments such as chiropractic care, physical therapy, injections or surgeries? If the treatments were helpful/not helpful, it can help the current treatment approach.
- Previous imaging for the complaint – Imaging of the region can provide more information that can be used to correlate with the symptom presentation
As you have seen, the patient history for low back pain is very detailed and can be very helpful for correctly diagnosing and treating the low back condition.
Yours in health,
Joshua Lederman, DC, MS, CCSP, Cert. MDT