Creating A History
In medicine, a "history" refers to a detailed, chronological record of your symptoms, past medical problems, risk factors for disease, medications and allergies. The reason the history is so important and helpful is that certain conditions tend to cause trouble in predictable ways. For example, a disk problem tends to cause radiating pain (pain that spreads) from the lower back down the back of the thigh. Muscle spasm almost never does this. So, even if your history doesn't identify the cause of your pain, it's a good starting point for sifting through the long list of possibilities.
When obtaining your history, your health-care provider will typically explore the answers to several questions:
- Who are you? Depending on your gender and age, some causes of pain are more likely than others. For example, if you're pregnant and in your third trimester, the pregnancy itself, with its attendant stretching of muscles and ligaments, is a common source of low back pain. However, in older people, degenerative joint disease or a compression fracture of a vertebra is a common cause of back pain. If you exercise regularly — particularly if you're an aggressive weekend warrior — your doctor may immediately suspect a pulled muscle.
- What is the severity and quality of your pain? Is your pain severe? How would you rank it on a scale of 1 to 10? Is it burning, throbbing, intermittent, fleeting, dull or sharp?
- When did your pain begin? Did the pain start suddenly or gradually? Did it follow an injury or a particular movement or activity?
- Has your pain progressed? Has your pain been getting better or worse? Is there a time of day when it is better or worse? Are there days when you do not feel pain?
- What triggers or relieves your pain? Are there things that improve the pain, such as a change in position? Are there things that clearly make your pain worse?
- What features are associated with your pain? Are there areas other than your lower back that are also painful, such as your joints? Does the pain extend into your legs? Have you noticed numbness, tingling or weakness in one or both legs? Have you noticed other problems along with the back pain, such as weight loss, fever or incontinence? (Even if you don't suspect a fever, checking your temperature a few times when the pain first arises can alert you to an infection.)
- What other medical conditions have you had? Have you had cancer, arthritis or colitis (bowel inflammation)? Have you been injured or had a recent infection?
- Are you taking any drugs? Do you take any prescription or over-the-counter drugs? Do you use any illegal or recreational drugs?