Back pain: Signs and symptoms

Woman holding back

Recognising back and neck pain

Back pain can be treated symptomatically but it is important to first rule out any underlying conditions that require attention from a physician.

Symptoms can include:1

  • Muscle spasms
  • Stiffness
  • Hot, burning or stabbing pains in the back and sometimes in the legs and feet
  • Pins and needles, numbness or weakness

  • Questions to ask your patient

    It is important to first take a general assessment of the patient’s pain, by asking about severity, onset, location and timing of the pain.2,3

    Next, more specific questions about back and neck pain can help guide treatment options.

    For back pain ask about:2

    • The onset, type and severity of pain
    • Any pain radiation
    • Duration of symptoms
    • Aggravating and relieving factors
    • Previous episodes
    • Associated symptoms such as morning stiffness, leg pain or weakness, muscle spasm, numbness or paraestheis, weight loss

    For neck pain ask about:3

    • Onset – establish if acute, chronic, recurring, sudden. Is onset related to trauma or a particular activity?
    • Nature of the pain – is it shooting or aching, what is the severity, timing and whether provoked or relieved by movement, position or certain activities
    • Location of pain and any radiation
    • Occupational history
    • Medical history
    • Symptoms of anxiety or depression
    • Previous injury or infection
    • History of cancer – assume the pain is related to the cancer until it is excluded
    • Presence of fever – assume neck pain is secondary to an infection until proven otherwise
    • Presence of symptoms of spinal cord compression – lower limb weakness or altered sensation, disturbance of bowel or bladder function

  • When to refer your patient for further care

    Appropriate interviewing can also help determine whether the patient should be referred for more detailed review.

    According to the NHS a patient should be referred to a GP or 111 if they have back pain and:4

    • A high temperature
    • Have lost weight without trying to
    • There’s a lump or swelling in the back or the back has changed shape
    • The pain does not improve after resting or is worse at night
    • The pain is made worse when sneezing, coughing ot pooing
    • The pain is coming from the top of your back (between the shoulders) rather than the lower back

    They should call 999 or go to A & E if they have back pain and:4

    • Pain, tingling, weakness or numbness in both legs
    • Numbness or tingling around your genitals or buttocks
    • Difficulty peeing
    • Loss of bladder or bowel control
    • Chest pain
    • It started after a serious accident e.g. car accident

  • Investigations that may be carried out

    Spinal x-ray may be indicated if there is suspicion of a specific pathology, such as a compression fracture due to osteoporosis or bone pain due to malignancy.2

    According to NICE, spinal x-ray or other imaging should not routinely be offered to diagnose non-specific back pain in primary care.2

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