Back and Neck Pain Approach Principles

CORE Back Tool

Consider Red Flags & DDx

• Red Flag

Q1: Where is your pain the worst?

• “Is it more on the back or leg?”
• “I can stop only one pain today, where do we start?”
• Both - Clarify
  • “Which one is worse?”
  • “If I can take away one pain …”
  • “Which one affect your function more?”

Q2: Is your pain constant or intermittent?

• “Is there ever a time, In your best position, in your best time, during the day, when your pain stops, even for a brief moment and even though it will return?”
• “When your pain stops, does it disappear completely? Is it totally gone?”
• True IM pain is NEVER:
  • Spinal malignancy
  • Active spinal infection

Q3: Does bending forward make your typical pain worse?

• “Can I see you do it?”
• “When does it hurt the most? What makes your pain worse?”
• Flexion-based actions:
  • Sitting down
  • Putting on socks, or tying shoe laces
  • Going up stairs

Q4: Has there been a change in your bowel or bladder function since your pain started?

• !CES - Cauda Equina Syndrome

Q5: What can’t you do now that you could do before you were in pain, and why?

Q6: (If the Pt < 45 yr old) Do you have morning stiffness longer than 30 min?