Back pain: Signs and symptoms

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.

Upper and middle back pain may present as aching, stiffness or sharp/burning sensations in that area.¹
Symptoms of lower back pain typically include tension/stiffness or soreness in that area.¹

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 example, ask²:

Where exactly does it hurt?

Do you feel pain anywhere else other than just the back or neck?

Describe the pain. Is it sharp? Or a dull ache? Does it feel sore? Or stiff? Or do you feel a particular sensation such as prickling?

Is the pain present all the time or does it just occur when you move, or perform any particular activity?

Does the pain ease after you have rested? Or does it get worse?

When did the pain start? Had anything happened before then that could explain the pain, for example a fall or an injury?
When to refer your patient for further care
Appropriate interviewing can also help determine whether the patient should be referred for more detailed review.

The patient should be immediately referred to an emergency department if the back pain is severe (particularly if it also involves the legs or middle and upper back),⁴ or if it is accompanied by any of the following¹:

Numbness or tingling around the genitals or buttocks

Difficulty urinating

Loss of bladder or bowel control

Chest pain

Fever of 38°C (100.4°F) or above

Unexplained weight loss

A swelling or a deformity in the back

It doesn't improve after resting or is worse at night

It started after a serious accident, such as after a car accident
Investigations that may be carried out
Once referred, physicians may conduct tests to rule out serious underlying causes, for example⁴:

X-rays to show skeletal alignment and diagnose you have arthritis or fractures.

Magnetic resonance imaging or computed tomography scans for herniated disks or problems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels.

Blood tests to identify infection or other condition with haematological biomarkers.

Bone scans are used in rare cases for suspected bone tumours or compression fractures caused by osteoporosis.

Electromyography to confirm nerve compression caused by herniated disks or narrowing of the spinal canal. (spinal stenosis)