Middle back pain Assessment Questionnaire

Why: to determine if acute or chronic.

Why: helps to determine cause of back pain e.g. dysfunction of intervertebral disc , back muscle strain, compression fracture of the spine.

Why: may reveal its likely origin e.g. aching, throbbing pain can indicate inflammation such as spondylitis; superficial steady diffuse pain can indicate local pain such as a muscular strain; boring deep pain can indicate bone disease such as bone tumor or Paget's disease.

Why: to determine if it is central or peripheral.

Why: Inflammatory pain is worse at night and in early morning; mechanical back pain due to injury is worse at the end of the day and after activity; Continuous pain present day and night is suggestive of a more sinister cause such as infection or bone tumor.

Why: inflammatory back pain causes pain at rest , relieved by activity ; mechanical back pain due to injury is exacerbated by activity and relieved by rest ;osteoarthritis causes pain with or after activity and relieved with rest; pain due to peptic ulcer may come on soon after eating or soon after going to bed at night.

Why: e.g. in elderly people must consider malignant disease (such as multiple myeloma and metastasis), osteoporosis, polymyalgia rheumatica, herpes zoster (shingles), ischemic heart disease and penetrating peptic ulcer; Scheuermann's disorder occurs in ages 11-17; it is important to consider scoliosis in adolescent children with backache.

Why: e.g. falls on the chest such as those experienced in body contact sports) - commonly lead to disorders of the thoracic spine (middle back).

Why: e.g. osteoarthritis, ankylosing spondylitis, Scheuermann's disease. Non-musculoskeletal causes of thoracic (middle) back pain include heart attack, angina, pericarditis, dissecting aneurysm, pneumothorax, pneumonia, oesophagitis, peptic ulcers, gallbladder disease, herpes zoster and infective endocarditis.

Why: e.g. people recovering from open heart surgery, when a longitudinal sternal incision is made and the chest wall is stretched out, commonly experience thoracic (middle) back pain.

Why: of cancers that may spread to bones e.g. breast, lung , prostate, thyroid, kidney, bladder, adrenal, melanoma and colorectal. The thoracic spine is the commonest site in the vertebral column for metastatic disease.

Why: early menopause, cigarette smoking , high caffeine intake , high alcohol intake , low calcium intake , physical inactivity , chronic corticosteroid use, Cushing's disease , hyperthyroidism , chronic renal failure.

Why: e.g. corticosteroids can lead to osteoporosis.

Why: e.g. Pain in the thoracic area is very common in people who sit bent over for long periods, especially working at desks. Students, secretaries and stenographers are therefore at risk, as are nursing mothers, who have to lift their babies. Brucellosis often occurs in workers in close contact with animal or carcasses.

Why: should be regarded as having a cardiac cause until proven otherwise. If the chest pain is non- cardiac , then the possibility of referral from the thoracic spine should be considered.

Why: if severe, prolonged and worse in the morning indicates inflammation such as spondylitis; Osteoarthritis causes stiffness at rest.

Why: may occur in acute vertebral osteomyelitis, spinal cord infection, tuberculosis, brucellosis, syphilis and salmonella infections.

Why: suggests inflammation, tumor or infection.

Why: disorders of the lower cervical (neck) area (such as whiplash) can cause referred pain to the upper thoracic (middle back) area.

Why: People who have "hunchbacks" secondary to disease such as tuberculosis, poliomyelitis or brucellosis suffer from recurrent pain in the middle back.

Why: suggests herpes zoster (shingles).

Why: common cause of middle back pain characterized by localized pain about 3-4 cm from the midline of the spine. Pain may be increased by twisting towards the side of the pain but eased by twisting in the opposite direction. Pain may be aggravated by coughing , sneezing and deep breathing. Pain may be relieved by firm pressure over the site.

Why: e.g. recurrent lower thoracic back pain usually in adolescents (boys more common than girls). Associated with kyphosis (deformity of the spine characterized by excessive flexion) and inability to touch toes.

Why: Chronic back pain can increase risk of causing or aggravating depression; Depression can continue to aggravate or maintain the back pain even though the provoking problem has disappeared.

Why: e.g. malaise, headache, weakness, fever, night sweats, muscle aches, backache, vomiting, fatigue, weight loss, enlarged lymph nodes. May be complicated by osteomyelitis, arthritis or spondylitis.

Why: e.g. benign tumor which cause pain aggravated by consuming alcohol and relieved by aspirin.

Why: e.g. history of widespread pain (neck to lower back), poor sleep patterns, fatigue. May be associated with depression, anxiety, tension headache, irritable bowel syndrome.

Why: e.g. heavy crushing central chest pain which may radiate into left arm or neck. May be associated with palpitations, shortness of breath or nausea. It can cause referred pain to the area between the shoulder blades.