A physical therapist is taking the history of a patient with low back pain. To differentiate inflammatory pain, which question is BEST to ask?

A physical therapist is taking the history of a patient with low back pain. To differentiate inflammatory pain, which question is BEST to ask?

• A. Is your pain constant or intermittent?
• B. What activity bothers you the most?
• C. Is it difficult to stand up straight after you've been sitting?
• D. Does your pain radiate down into the leg?

Answer: (A)

When assessing low back pain, how the pain behaves over time is a key clue. Inflammatory back pain tends to be constant, persisting even at rest and often worsening at night, whereas mechanical back pain tends to come and go with movement, posture, or specific activities. So asking whether the pain is constant or intermittent directly probes whether the pain is persistent independent of activity, which is most characteristic of inflammatory processes. The other questions can provide useful context but are less specific. Asking what activity bothers you the most highlights whether pain is driven by movement or load, which points toward a mechanical pattern. Asking if it's difficult to stand up straight after sitting can reflect stiffness or posture-related issues but isn’t as clearly differentiating. Asking about radiation down the leg addresses nerve involvement rather than the inflammatory vs mechanical nature of the pain.

When assessing low back pain, how the pain behaves over time is a key clue. Inflammatory back pain tends to be constant, persisting even at rest and often worsening at night, whereas mechanical back pain tends to come and go with movement, posture, or specific activities. So asking whether the pain is constant or intermittent directly probes whether the pain is persistent independent of activity, which is most characteristic of inflammatory processes.

The other questions can provide useful context but are less specific. Asking what activity bothers you the most highlights whether pain is driven by movement or load, which points toward a mechanical pattern. Asking if it's difficult to stand up straight after sitting can reflect stiffness or posture-related issues but isn’t as clearly differentiating. Asking about radiation down the leg addresses nerve involvement rather than the inflammatory vs mechanical nature of the pain.