Goals of the initial assessment

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The initial assessment of patients with CLBP needs to be thorough and systematic. The goals of the initial evaluation are as listed in Box 37.2. Part of the initial evaluation should include a screen for risk factors for chronicity.11 These so-called "yellow flags'' are psychosocial factors that increase the risk of developing or maintaining chronic pain and disability, and include:

• inappropriate attitudes and beliefs about back pain;

• inappropriate pain behavior, such as fear-avoidance;

• work satisfaction and related return-to-work issues;

• associated emotional issues, such as depression, anxiety, or stress.

Assessment for the presence of yellow flags and management suggestions are detailed elsewhere.1

Box 37.2 Goals of the initial assessment of

chronic low back pain patients


Identify the reason(s) why they are seeking care


Identify patients with an evolving chronic pain



Don't be fooled by certain subgroups of


- the chronic low back pain patient you have

seen regularly over years;

- the patient with psychological overlay;

- the poor historian;

- the patient who has been seen by everyone


- the patient who has been sent with a

diagnosis of "low back pain.''


Assessment of pain


Assessment of disability


Identify red flag medical issues by history and



Identify yellow flag psychosocial issues


Look for diagnostic subgroups

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