If it is not typical, the onset of pain and location, radiation, effect of activity, severity, trauma or fall must be characterized. Age, occupation, aggravating factors such as movement, cough etc. Review of Symptoms . Weight loss is seen in metastatic cancer. Pain that worsens with exercise, especially while walking, suggests osteoarthritis or spinal stenosis, while improvement with exercise suggests a seronegative spondyloarthropathy.
Radicular pain worsened by coughing or sneezing suggests nerve root impingement.
Past Medical History . Past history of carcinoma, back injury, kidney stones, exposure to TB and other chronic diseases is important. Objective Data Physical Examination - Vital Signs. Temperature, pulse, blood pressure. - General. Temporal wasting, pallor.