What questions should be asked and what interventions are appropriate for a 15-year-old presenting with flank pain or back pain?

Questions for SOAP Note Assessment of a 15-Year-Old with Flank/Back Pain

A focused diagnostic approach with specific questions about pain characteristics, associated symptoms, and risk factors is essential to determine the underlying cause of flank/back pain in adolescents and guide appropriate management.

Pain Characteristics

• Ask about the exact location of pain (flank, lower back, mid-back, unilateral or bilateral) 1
• Determine the onset, duration, and progression of pain (acute vs. chronic) 1
• Assess pain quality (sharp, dull, constant, intermittent) 1
• Inquire about pain intensity on a scale of 0-10 1
• Ask about timing of pain (worse at night, morning, or with activity) 1
• Determine if pain radiates to other areas (leg, abdomen, groin) 1

Aggravating and Relieving Factors

• Ask what makes the pain worse (specific activities, positions, movements) 1
• Determine what relieves the pain (rest, medications, position changes) 1
• Inquire about response to any previous treatments or medications 1

Associated Symptoms

• Ask about urinary symptoms (frequency, urgency, dysuria, hematuria) 1, 2
• Inquire about neurological symptoms (numbness, tingling, weakness in legs) 1
• Ask about bowel or bladder dysfunction (incontinence, retention) 1
• Determine presence of fever, weight loss, or night sweats 1, 3
• Inquire about abdominal symptoms (nausea, vomiting, pain) 2, 4

Medical and Social History

• Ask about recent trauma or injury to the back 1, 3
• Inquire about previous episodes of similar pain 1
• Determine sports participation and activity level 3, 5
• Ask about recent surgeries or procedures 5
• Inquire about family history of kidney stones, back problems, or inflammatory conditions 1, 4

Red Flag Questions

• Ask about constant pain, night pain, or pain that wakes the patient from sleep 1, 3
• Determine if there is pain persisting beyond 4 weeks 1, 3
• Inquire about any systemic symptoms (fever, weight loss, fatigue) 1, 3
• Ask about neurological symptoms (weakness, numbness, tingling) 1
• Determine if there is bowel incontinence or urinary retention 1

Physical Examination Components

• Perform postural inspection (scoliosis, kyphosis) 3, 6
• Assess for point tenderness along the spine and flanks 3, 6
• Evaluate range of motion of the spine 3, 6
• Perform neurological examination (strength, sensation, reflexes) 1
• Conduct straight-leg-raise test to assess for nerve root compression 1
• Perform abdominal examination to assess for tenderness, masses 2, 4

Diagnostic Testing Considerations

• Initial imaging should include AP and lateral spine radiographs if symptoms persist beyond 4 weeks or if red flags are present 1, 6
• Consider urinalysis if urinary symptoms or flank pain suggest kidney involvement 2, 4
• Order complete blood count and erythrocyte sedimentation rate if infection or inflammation is suspected 1, 6
• Consider MRI for persistent symptoms, neurological findings, or suspected serious pathology 1, 6
• Reserve CT scan for suspected urolithiasis or when MRI is contraindicated 2, 4

Treatment Approach

• Recommend relative rest and activity modification based on symptoms 1
• Suggest application of heat for short-term pain relief 1
• Consider acetaminophen or NSAIDs for pain management if no contraindications 1
• Provide education about expected course and self-care options 1
• Consider physical therapy for persistent symptoms 1
• Refer to specialist if red flags are present, symptoms persist beyond 4 weeks, or if diagnostic imaging reveals specific pathology 1, 3

Follow-up Plan

• Schedule reassessment in 2-4 weeks if symptoms persist 1
• Consider earlier follow-up if symptoms worsen or new symptoms develop 1
• Develop a return-to-activity plan if the patient is an athlete 3, 5