Important questions to ask when obtaining a history from a patient with low back pain
One can use the helpful mnemonic P-Q-R-S-T (the components of an electrocardiogram tracing) when approaching any patient with pain:
P—Provocative and palliative factors: sitting (worse with discogenic), walking (worse with spinal stenosis—relieved with forward flexion), supine (pain unrelieved if cancer or infection), Valsalva maneuver (worse with intrathecal or radicular process), lumbar extension (worse with spinal stenosis and facet arthritis) versus flexion (worse with lumbar strain or fibromyalgia). What is the position of maximal comfort, and does this reduce or eliminate pain or radicular symptoms?
Q—Quality of pain: burning/tingling, numb, sharp or dull?
R—Radiation of pain: into leg (radicular), saddle area with bowel/bladder dysfunction (cauda equina syndrome), bilateral buttock or thigh (spinal stenosis, ankylosing spondylitis, or referred from intraabdominal pathology)?
S—Severity of pain and systemic symptoms: pain scale 1 to 10; fever, weight loss, change in bowel habits, etc.?
T—Timing of pain: date of onset, associated trauma, and prior similar episodes?
