Assessment

Location of pain

Thoracic pain should alert you to other causes, such as intra-abdominal or thoracic conditions (pancreatitis or aortic dissection, gastric, duodenal ulceration or retroperitoneal pathology, for example).

Paraspinal pain may be more pathognomonic of renal aetiology such as pyelonephritis or renal cell cancer.

It’s also worth establishing if there are any signs or symptoms of sciatica (or lumbar radiculopathy). This often presents with unilateral leg pain that radiates below the knee to the foot or toes (but not always). Usually in these cases the leg pain is much worse than the back pain; sometimes the back pain is minimal or absent.

Does this sound familiar for Derrick?