When Back Pain Keeps Coming Back: Back Pain Basics (A Diagnostic Evaluation of Back Pain)

The evaluation of back pain can be a pain in the neck or a back-breaking exercise, so to speak.

However, the diagnosis hinges always on a focused History and Physical Exam and not really on labs or imaging. Knowing what to ask and where to look can make the evaluation of this all-too-common condition manageable for the internist. 

This lecture focuses on the evaluation of low back pain and will guide the reader on the key points in the Hx and PE and prevent unnecessary testing/imaging.

It also presents 3 “unusual” cases of low back pain of which may be disabling if not recognized immediately.

The pandemic provides a current challenge in evaluating back pain (or musculoskeletal [MSK] pain in general) in that a lot of patients would prefer to do telemedicine rather than a clinic visit. Telemedicine, while convenient, makes it difficult to evaluate MSK conditions because of the inability of the clinician to perform a full Physical Examination. Though it carries the advantage of doing screening and History-taking before a 1st clinic visit, the lack of physical interaction to do maneuvers such as palpation, percussion, auscultation make the virtual encounter challenging.

Fortunately, there are still several things that can be done with inspection, and with the proper guidance/demonstration, one can do a demonstration over camera of some simple maneuvers that a patient can do, to elicit some important clinical findings. I found this journal to be helpful and I am linking the article below:


The journal article talks about the requirements and barriers to telemedicine for spine examination and provides suggestions on how to maintain patient rapport and and instructions on how to conduct a virtual Physical Examination. They also have a short instructional video and some tables on how this could be done.

Overall, the evaluation of back pain is difficult, especially with the limited face to face encounters nowadays, but with a good fund of knowledge of what to ask and where to look and with the ability to leverage technology to our advantage, then we should be able to assist and take care of our patients with this condition better.

A Lay Fora on Gouty Arthritis

On Making Science Interesting, The “Curse of Knowledge” and The Myth of “Dumbing Down” (A Letter to My Co-Fellows)

Dear Co-Fellows:

I believe that we are all like 13 year olds learning a new and difficult topic, especially in a challenging field as rheumatology. And sometimes, we have been told not to be “too basic” or “too elementary” in our explanations; that we should use the scientific language to speak and explain…

I beg to differ. I believe that we should simplify as much as we can to the point of telling stories or simple analogies.

I’ve been reading a book called Made to Stick and it has helped me a lot. I will share some concepts to you when we have free time. I shared one this morning, about the “Curse of Knowledge.” It simply means that once we have become knowledgeable about a certain topic, we tend to forget how we learned it (whether it was the hard way or the easy way), and sometimes, we find it hard to understand why people don’t understand what we talk about (when it seems soooo easy to us). I am guilty of this curse, especially on the technical, geeky stuff. A lot of times I find it hard to understand why people can’t understand these stuff (like, why Ken can’t get the concept of Cloud-based files storage like Dropbox. Hehe). That is my “Curse of Knowledge.” What I “hear” in my brain, and the cadence by which I hear it is not the same as what Ken “hears” or how fast he “hears” it. I need to simplify (mistakenly perceived by others as “dumbing down”) so that people can understand.

The book I am reading, Made to Stick taught me the principle of accuracy vs accessibility when teaching. Let me share this brief excerpt:

“We discussed the Curse of Knowledge in the introduction—the difficulty of remembering what it was like not to know something. Accuracy to the point of uselessness is a symptom of the Curse of Knowledge. To a CEO, “maximizing shareholder value” may be an immensely useful rule of behavior. To a flight attendant, it’s not. To a physicist, probability clouds are fascinating phenomena. To a child, they are incomprehensible.

People are tempted to tell you everything, with perfect accuracy, right up front, when they should be giving you just enough info to be useful, then a little more, then a little more.”(Excerpt From: Heath, Chip. “Made to Stick.” Random House Publishing Group, 2008. iBooks.)

Also, watching this 11 minute TED video by Tyler DeWitt awhile ago, inspired me once more, to overcome this “Curse of Knowledge”  and shy away from the myth of “Dumbing Down” and be able to teach in a simple way. I hope you too will find it useful as we become educators in the near future 🙂

Here’s the video: 

Enjoy guys 🙂



Rheumatology Fellows 2013

Angeline Therese D. Magbitang, MD

Ana Kristina G. Rubio, MD

Allan D. Corpuz, MD

Ana Teresa S. Hernandez, MD

Juneth Ria L. Hipe, MD

Kenneth D. Tee, MD