Tests for behavioral or nonorganic cause for back pain

What other tests have been identified as suggesting a behavioral or nonorganic cause for back pain?

• Sit-up—a patient with significant back pain cannot do a sit-up. Patients with organic back pain will roll over to their side and push up to sitting position. If patient can do a sit-up, the pain is not typically severe.

• Shoes and socks sign—patients with significant anatomic back pain should have problems putting on shoes and socks. If these actions are no problem, back pain usually is not severe.

• Mankopf’s test—pain should raise the pulse rate ≥5% (unless on beta blockers).

• O’Donoghue’s maneuver—patients with anatomic back pain should have greater passive range of motion than active range. If not, consider nonorganic causes of pain.

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