The Low Back Pain Diagnosis Algorithm

1. Have you lost sensation around your genital region, or have you lost control of your bladder and bowels?

If yes go to your nearest accident and emergency department these symptoms are potentially serious and you need to be assessed as a matter of urgency.

 

2. Have you got;

Persistent fever over 100 degrees F

History of intravenous drug abuse

History of long-term steroid use

Constant Pain that doesn’t vary with movement

Pain worse at night

Family or personal history of cancer

If this is your first episode are you aged  >20 or <50

Is there any significant weakness

Serious accident recently or at time of onset e.g. car crash

Obvious deformity

Unexplained weight loss

Pain in your chest or further up your back?

Pain below the knee

 

If you answer yes to any of these questions you need to see your general practitioner first and preferably a pain consultant or spinal surgeon first for investigation.

3. If you answer no, then complete the pain disability questionnaire to score your current pain status so that you can objectively evaluate how you progress.

4. Then review the table below to work out which type of pain you have, either one of these or mixed.

 

Nociceptive pain	Neuropathic pain	Central sensitisation
History of damage to body tissue in the previous 6-8 weeks	History of a problem with a nerve or disease of the nervous system, or posttraumatic/ postsurgical damage  to the nervous system. E.g. the brain, spinal cord or sciatic nerve	No history of an obvious cause, damage or a disease.
Pain diminishes according to the natural healing phases	Indications from diagnostic examinations reveal anomaly (abnormality) of the nervous system.	No findings when examined.
Related to tissue damage or potential damage. E.g. an ankle sprain or almost burning a hand.	Pain related to a medical or whole body cause such as stroke, herpes, diabetes, or some form of nerve degeneration disease. E.g. Parkinson’s	No medical cause for the pain established.
Local pain, most often with diagnostic signs such as swelling, bruises, skin coloration, etc.		Several areas are painful.
Pain is sharp, aching or throbbing.	Pain is burning, shooting or prickling.	Pain is vague and dull.

Table 1. Adapted for the general public from Nijs et al. (2014)

 

If you fit best in to the neuropathic category then proceed to the neuropathic assessment linked here.

 

5. If you fit in to one of the other two categories then complete the following two questionnaires.

The Widespread Pain Index is linked here. Complete part A.

The Central Sensitization Inventory is linked here. Complete part 1.

If your score for the Widespread Pain Index part A is >7/19 and >40/100 for part 1 of the Central Sensitization Inventory then you most likely fit the primarily central sensitisation category and should proceed to the central sensitisation category linked here.

If not then you likely fit the primarily nociceptive category and should proceed to the nociceptive assessment linked here.