[Medical history for musculoskeletal pain : When we talk to patients, we get exciting information]

Even today, the diagnosis and treatment of acute and chronic back pain is often an unsolved and sometimes unsolvable problem. In many cases, clinical examination, state-of-the-art imaging and supplementary laboratory chemistry only allow uncertain conclusions to be drawn about the almost always complex pathogenesis [1]. Great importance is attached to the medical history. However, little of value has been written about it. This article is primarily intended to highlight and interpret possible answers given by patients to specific questions.

Many studies on taking medical history by asking specific questions in cases of musculoskeletal pain lack a detailed interpretation of the patient's answers with regard to the difficult clinical decision-making process for diagnosis. The aim here is to encourage the effective incorporation of specific patient statements into the overall assessment.

The work is based on the personal experience of the author, who has conducted almost 100,000 (in words: one hundred thousand) individual consultations with patients in 40 years of professional experience in clinic and practice and has often accompanied mechanism-oriented therapy for many years. Standardized questionnaires and the evaluation of the patient's pain drawings were used on a regular basis. This article falls into the EBM category D, Expert Opinion.

In an estimated 90% of cases, the decision to make a diagnosis based on the patient's medical history proved to be correct. Of course, all the examinations required by the criteria of "good clinical practice" were carried out, whereby subtle clinical exploration undoubtedly also plays a very important role [2].

Taking a subtle history [3] can shed light on so-called "non-specific" low back pain and other complex musculoskeletal pain syndromes.