The condition of the patient with low back pain as reflected to the attending physician should include the following.
1.Provide the patient’s age and occupation
2.Detail the characteristics of the pain attack
When did the pain appear?
Does the pain appear slowly and insidiously, worsen rapidly, or occur suddenly? If the pain is sudden, suggest a mechanical factor.
Is there a history of injury? If sudden twisting or pulling, sudden sneezing during flexion position, etc.
3. Detail all symptom-related medical history
Is there a history of similar injuries in the past?
Have you had similar spinal discomfort in the past?
4.Detail the site and characteristics of the pain
Where is the pain located? Is the pain limited or radiating?
Is the pain continuous or intermittent? The latter suggests that the cause of the pain is mechanical.
Under what conditions is the pain aggravated or relieved?
For mechanical back pain, bending or sudden movement can aggravate the pain, while lying flat, especially on a hard bed or applying local heat, or even sitting down, can reduce the pain. For back pain caused by spinal lesions, especially due to tumor, infection or inflammatory diseases, patients are mostly unable to find a position that can relieve the pain, and persistent nocturnal pain is one of its characteristics.
5.Detail the direction of pain radiation
Does the pain radiate to the legs?
If yes, how far does the pain radiate and in what area is the pain located?
(Nerve root involvement commonly causes sensory disturbance below the knee joint)
6.Detail whether the activity is affected
Does the patient feel weakness, muscle atrophy or tremors in the lower extremities?
Is there any gait abnormality or balance disorder? Is there a tendency to fall or foot drop?
7. Describe other related conditions
Is there any mild discomfort, fever or other joint discomfort?
Is there any weight loss?
Is there any colon or other gastrointestinal disorders?
Are there any urinary or genital symptoms, especially urinary retention or incontinence?
Is there respiratory distress?
Are there any symptoms related to central nervous system disorders?