Pattern Recognition

Three distinct patterns of low back pain symptoms can be recognized:

1. Nonspecific back symptoms

2. Sciatica (pain radiating to a leg)

3. Symptoms of a potentially serious spinal condition (eg, tumor, infection, spinal fracture) and major neurologic compromise as with the cauda equina syndrome, bowel or bladder dysfunction, or weakness.

The most important elements of the history are the characterization of the presenting pain and determination of the presence or absence of sciatica. Particular note should also

be made of any preceding trauma including strenuous lifting, prior attacks of pain, prior evaluations, prior and current treatment, and the duration and progression of symptoms. The use or abuse of drugs also should be noted, as well as the presence

of symptoms consistent with malignancy or infection. The patient should be asked about the presence and localization of weakness, numbness, dysesthesias and estheias, bladder, bowel and sexual dysfunction, which might indicate spinal cord compression; and about any accompanying abdominal or flank pain which might indicate an intra-abdominal or pelvic origin of the pain. The table 1 lists the "red flags" that should alert the physician of a more serious underlying condition