Questionnaire for Doctors and Nurses to Evaluate a Patient's Back Pain
Enhance patient evaluation and treatment planning with a comprehensive back pain questionnaire to accurately assess and address the underlying causes of a patient's back pain. Seamlessly add the evaluation and notes to your EMR.
Copy templates to use them anywhere:
Back Pain Template
This dot phrase template, or snippet, can be used to treat a patient with back pain. It uses the formmenu command, the note command and the if command.
This snippet provides a series of questions to ask a patient about their back pain. It includes a variety of different patient types with questions customized to each type.
Once copied to your Text Blaze account, you can customize this snippet to your use.
Back Pain Example
{note}Back Pain Red Flags:{formmenu: default=1. Location and history; 2. Numbness or weakness; 3. Incontinence; 4. IVDA; 5. F/C; 6. Immunesuppression; 7. Female < 50 yo CA / wgt loss; 7. Female > 50 yo CA / wgt loss; 7. Male < 50 yo CA / wgt loss; 7. Male > 50 yo CA / wgt loss; 8. Sleep at night; 9. Worsen/alleviateion triggers; 10. What have you tired; 11. What has helped in the past; name=condition}
{endnote: trim=right}
{if: condition="1. Location and history"; trim=yes} I see you have back pain What part of the back -- lower or upper (please be precise)? When did this start? Any fall or trauma? Any heavy lifting? Have you had similar pain before?
{elseif: condition="2. Numbness or weakness"; trim=yes} Any numbness or tingling of either leg or foot? Any weakness of either leg or foot?
{elseif: condition="3. Incontinence"; trim=yes} Any incontinence of urine or stool?
{elseif: condition="4. IVDA"; trim=yes} Pardon the personal question but do you self-inject drugs? I ask because that can put you at risk of a spine infection which is an emergency
{elseif: condition="5. F/C"; trim=yes} Any fever or chills?
{elseif: condition="6. Immunesuppression"; trim=yes} Any possibility of immune-suppression? Do you take steroids? Do you take immune-suppressing drugs? Do you have an risk of HIV?
{elseif: condition="7. Female < 50 yo CA / wgt loss"; trim=yes} Have you ever been diagnosed with cancer? Have you been losing weight unexpectedly Are you up to date on cancer screenings: PAP smear?
{elseif: condition="7. Female > 50 yo CA / wgt loss"; trim=yes} Have you ever been diagnosed with cancer? Have you been losing weight unexpectedly Are you up to date on cancer screenings: colonoscopy, mammogram, PAP smear?
{elseif: condition="7. Male < 50 yo CA / wgt loss"; trim=yes} Have you ever been diagnosed with cancer? Have you been losing weight unexpectedly
{elseif: condition="7. Male > 50 yo CA / wgt loss"; trim=yes} Have you ever been diagnosed with cancer? Have you been losing weight unexpectedly Are you up to date on cancer screenings: colonoscopy and prostate exam?
{elseif: condition="8. Sleep at night"; trim=yes} When is the back pain at its worst? In the morning? At the end of the day? Can you sleep at night?
{elseif: condition="9. Worsen/alleviateion triggers"; trim=yes} What makes the back pain worse? What makes it better?
{elseif: condition="10. What have you tired"; trim=yes} What have you done or taken to alleviate the back pain?
{elseif: condition="11. What has helped in the past"; trim=yes} Have you had similar back pain in the past? What worked to alleviate the pain?{endif: trim=yes}
_
