Primary care work-up of acute and chronic symptoms

Low back pain may present as acute pain or as an acute exacerbation of a chronic pain problem. Acute low back pain is self-limited, with 90% of affected individuals recovering within 3 weeks to 3 months. Pain duration of more than 4 weeks warrants a more complete work-up, including ruling out malignancy. Pain duration of more than 6 months defines chronic pain, which is frequently associated with affective and behavioral components. When taking the history, determine pain intensity, location, pattern of radiation, onset, and duration. A gentle physical exam may help locate the source of pain through palpation and maneuvers, such as the straight leg raise test. Imaging is recommended for patients with a clinical finding that raises suspicion of spinal malignancy.