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Middle back pain Assessment Questionnaire

Questions Your Doctor May Ask - and Why!

During a consultation, your doctor will use various techniques to assess the symptom: Middle back pain. These will include a physical examination and possibly diagnostic tests. (Note: A physical exam is always done, diagnostic tests may or may not be performed depending on the suspected condition) Your doctor will ask several questions when assessing your condition. It is important to openly share any pertinent information to help your doctor make an accurate diagnosis.

It is also very important to bring an up-to-date list of all of your all medical conditions, medications including dosages, and names of numbers of any specialist you see.

Create your printable checklist by answering questions that your doctor may ask below:

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  1. When did the middle back pain start?

    Why: to determine if acute or chronic.

  2. Did the middle back pain start after any injury or lifting?

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

  3. Nature of the pain?

    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.

  4. Where is the back pain worst and can you point to the area of maximal pain?

    Why: to determine if it is central or peripheral.

  5. Is your back pain worse when you wake in the morning or later in the day?

    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.

  6. Aggravating and relieving factors?

    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.

  7. What is the age of the person with middle back pain?

    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.

  8. History of trauma to chest wall?

    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).

  9. Past Medical history?

    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.

  10. Past Surgical history?

    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.

  11. Past cancer history?

    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.

  12. Risks of Osteoporosis?

    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.

  13. Medication?

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

  14. Occupational history?

    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.

  15. Chest pain?

    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.

  16. Back stiffness?

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

  17. Pain, swelling or stiffness in any other joints in the body?
  18. Fever?

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

  19. Night pain?

    Why: suggests inflammation, tumor or infection.

  20. Neck pain?

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

  21. Kyphosis (deformity of the spine characterized by excessive flexion)?

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

  22. Rash near where you have the pain?

    Why: suggests herpes zoster (shingles).

  23. Symptoms of dysfunction of the thoracic spine?

    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.

  24. Symptoms of Scheuermann's disease?

    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.

  25. Symptoms of depression?

    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.

  26. Symptoms of brucellosis?

    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.

  27. Symptoms of osteoid osteoma?

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

  28. Symptoms of Fibromyalgia syndrome?

    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.

  29. Symptoms of heart attack or angina?

    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.

Conditions listing medical symptoms: Middle back pain:

The following list of conditions have 'Middle back pain' or similar listed as a symptom in our database. This computer-generated list may be inaccurate or incomplete. Always seek prompt professional medical advice about the cause of any symptom.

Select from the following alphabetical view of conditions which include a symptom of Middle back pain or choose View All.

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