Medically Fit For Exams
Medically Fit For Exams

Back pain history taking


  • Wash hands and introduce yourself
  • Check patient’s name and DOB

Differential diagnoses




Disk prolapse

Spinal stenosis


Renal disease (calculi, pyelonephritis)

Pancreatic pain, epigastric radiating to back (pancreatitis)

Cauda equina syndrome

Dissecting aorta

  • Ask if you can talk to them before they see the doctor


History of presenting complaint

  • Ask what has brought them in today
  • Ask the patient to tell you more about the back pain
  • Use SOCRATES mnemonic
    • Site
      • Lumbar
      • Thoracic (?pancreatic)
      • Ask about epigastric pain
      • Flank/loin
    • Onset
      • Sudden (osteoporotic fracture, injury, disk prolapse, dissecting aorta, possibly cauda equine)
      • Was there a precipitating event?
    • Character
      • Shooting (neuropathic eg disk prolapse, stenosis cauda equina)
      • Tearing (aortic dissection)
      • Dull/ache (musculoskeletal)
    • Radiation
      • Down legs
        • To feet (sciatica)
        • To thighs (slipped disk, cauda equina)
        • From epigastrum (pancreatitis)
        • To groin (renal calculi)
    • Associated symptoms
      • Numbness (disk prolapse, cauda equina)
      • Weight loss/fatigue (cancer/metastatic disease)
      • Stiffness (osteoarthritis)
      • Fever (pancreatitis, pyelonephritis)
    • Time-course
      • Constant (cancer)
      • Intermittent
      • Morning stiffness more or less than 30 mins
      • Wakes up in night? (cancer, inflammatory causes, infection)
    • Exacerbating/relieving factors
      • Relieved on rest (mechanical, disk prolapse, cauda equina)
      • Relieved on movement (inflammatory, cancer)
      • Possibly relieved by anti-inflammatories (inflammatory)
      • Painkillers?
    • Severity
      • Is the pain interrupting any daily tasks/anything they can’t do any more
  • Cauda equina screen
    • Sudden onset of:
      • Saddle anaesthesia and/or leg weakness
      • Incontinence of urine or faeces
      • Erectile dysfunction
  • ICE
    • Ask if there is anything that they are concerned about
    • Ask if there is anything they think is causing their symptoms
  • Systems review
    • Headache, faints, fits
    • Changes to vision, sensation
    • Cough
    • SOB
    • Chest pain
    • Abdo pain
    • Changes in bowel habits
    • Changes in waterworks
    • Other aches and pains
  • Summarise and check what they have told you


Past medical history

  • Ask if they have had a similar problem with their back in the past
    • What helped?
  • Ask if they have any medical problems, current or past


Drug history

  • Ask if they take any regular medication, and if it has been changed recently
  • Ask if they take any over the counter medication
  • Ask if they take any supplements



  • Ask if they have any allergies
  • Ask what happens


Family history

  • Ask if anyone in their family has:
    • Problems with their back
    • History of cancer
    • Arthritis
    • Any other medical conditions


Social history

  • Smoking and pack years
  • Drinking and weekly units
  • Ask about occupation
    • Heavy or manual work?
    • Stress at work
  • Ask about who they live with and type of accommodation
  • Ask if the back pain is interrupting any daily tasks




  • Ask the patient if they have any questions or other concerns
  • Ask if there is anything they think you have missed
  • Summarise again if necessary
  • Thank the patient for talking to you


Next steps

In all cases

Examine back and spine and gait, brief neurological examination of legs, FBC, LFTs, U&Es, CRP/ESR

If suspect disk prolapse

CT/MRI imaging

Cauda equina

Urgent referral/admit to neurosurgeons

If suspect osteoarthritis

Spine x-ray, DEXA

Cancer referrals for back pain

>60, back pain with weight loss


2 week wait CT or ultrasound if CT unavailable












Back pain history taking.docx
Microsoft Word document [549.4 KB]

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