Inflammatory back pain tends to ease with movement, not rest, and is often worse at night or in the early morning. A short pair of questions, how long stiffness lasts after waking and whether pain wakes the patient in the second half of the night, helps separate it from mechanical pain and prompts earlier referral.
- Ask how long morning stiffness lasts.
- Ask whether pain wakes the patient in the second half of the night.
- Ask whether exercise improves or worsens it.
- Refer when the pattern is inflammatory, even if tests are normal.
Why it matters
Normal blood tests and X-rays do not exclude early inflammatory disease.
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