Middle Back Pain Assessment

Is the pain between the shoulder blades or closer to the spine?

Between the shoulder blades

Closer to the spine

Both

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Does the pain radiate to your ribs or sides?

Yes, it radiates to the ribs or sides

No, it stays in the back

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Do you spend long hours sitting or working at a desk?

Yes, I spend most of my day sitting

Occasionally, I sit for extended periods

No, I am usually on my feet

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What type of pain do you feel?

Sharp, sudden pain

Aching, dull pain

Tightness or stiffness

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Does the pain improve with stretching or movement?

Yes, movement helps

No, it feels worse with movement

It stays the same

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How long have you been experiencing this pain?

Less than a week

1-4 weeks

Over a month

Other

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How would you rate your pain on a scale of 1-10?

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Have you taken any medications or treatments for this pain?

Yes

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Is this pain the first time you’ve experienced it, or have you had similar pain before?

Yes, this is the first time I’m experiencing this type of pain.

No, I’ve had this type of pain before, but it went away after a while.

No, I’ve had similar pain before, and it has been recurring.

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Have you ever been involved in a road traffic accident (car, bike, or pedestrian)?

Yes, I’ve been in a road traffic accident before and sustained injuries.

Yes, but I did not experience significant injuries at the time.

No, I’ve never been in a road traffic accident.

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Have you ever had any fractures or dislocations in your body, particularly around the affected area?

Yes, I have had a fracture or dislocation in the area experiencing pain.

Yes, I’ve had a fracture or dislocation in another area of my body.

No, I’ve never had any fractures or dislocations.

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Have you undergone any surgeries in the past, especially related to the area experiencing pain?

Yes, I’ve had surgery in the affected area (e.g., hip, shoulder, back).

Yes, I’ve had surgeries elsewhere in my body but not in the affected area.

No, I have never had any surgeries.

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Do you have any other medical conditions that might be related to the pain, such as arthritis, diabetes, or autoimmune disorders?

Yes, I have a medical condition (e.g., arthritis, diabetes, fibromyalgia) that may be related to the pain.

No, I don’t have any known medical conditions related to the pain.

I’m not sure, but I’ve been diagnosed with other health issues.

Please select an option before proceeding.

Personal Details

First Name

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Last Name

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Body Type

Age

Minor Name

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Middle Back Pain Assessment

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