lower back pain
Enable an AI agent to recognise a reported lower back pain episode, record its effects and uncertainties, and identify appropriate assessment or support within its authority.
Research draft, second pass
A second pass drafted this model: the structure a model of this thing needs, and what is known about it in the world. The line under this one says how the second half was obtained - researched against sources, or recalled without web access, in which case nothing here was read anywhere and every claim is a lead to verify. Unreviewed either way.
recalled by Codex without web access - no source was read
Researched by: Codex
Purpose and description
Enable an AI agent to recognise a reported lower back pain episode, record its effects and uncertainties, and identify appropriate assessment or support within its authority.
Lower back pain is pain between the lower rib margins and the gluteal folds, with or without accompanying leg pain, that describes a symptom rather than a single underlying disease.
It can be Elicit and summarise a lower back pain history while marking missing or uncertain information.; Track pain, function and recovery goals using consistent measures and recall periods.; Apply an approved assessment pathway to recorded symptoms and surface the need for human review within the agent's role.; Prepare a handover that separates personal reports, examination findings and clinical interpretations.; Compare reported outcomes across care episodes without prescribing treatment or asserting unsupported causation..
Distinguishing features
The reported painful area includes the lower back; isolated neck, thoracic, hip or flank pain should not be relabelled solely because it is nearby.
Lower back pain can be recorded without a confirmed structural cause; an imaging finding alone does not establish the presence or explanation of experienced pain.
Pain spreading into a leg is recorded separately from local back pain, and spread alone is not treated as confirmation of a nerve-root disorder.
A symptom episode is distinguished from an underlying disease diagnosis, allowing the two to be linked without making them interchangeable.
Persistent pain and repeated episodes are distinguished using the reported timeline and intervening recovery, with any classification convention explicitly named.
Scope
+ The person's description of pain in the lower back and any spread beyond it
+ Episode onset, persistence, recurrence and changes over time
+ Pain intensity, interference with everyday activities and personally important goals
+ Associated symptoms and contextual information relevant to assessment priority
+ Recorded clinical interpretations, care experiences and unresolved uncertainty
- Detailed models of underlying spinal, neurological, inflammatory or visceral diseases
- Full anatomy and biomechanics of the lumbar spine
- Medication prescribing, dosing and interaction management
- Detailed execution of imaging, surgery or rehabilitation procedures
- Independent psychiatric diagnoses or occupational compensation determinations
Characteristics
- Pain location and distribution
- Person-marked body area; left, right or bilateral; local or spreading; destination of spread Establishes whether the report belongs within this model and preserves distinctions from adjacent pain presentations.
- Episode timing
- Onset date or estimate; elapsed days, weeks or months; symptom-free intervals Supports tracking and duration classifications without confusing recurrence with continuous symptoms.
- Pain intensity
- Named scale and anchors, such as 0-10; recall period; rest or activity context Makes repeated reports interpretable while retaining the person's subjective experience.
- Functional interference
- Named questionnaire score or task-specific limits, with units such as walking minutes or sitting tolerance Shows consequences that an intensity score alone cannot capture.
- Symptom trajectory
- Improving, stable, fluctuating, worsening or unclear; observation period Makes changes visible and supports reassessment.
- Associated symptom assessment
- Present, explicitly absent, unknown or not assessed for each named symptom; onset and progression Prevents missing information from being mistaken for reassuring evidence.
- Attribution status
- Unassessed, cause undetermined, suspected cause or clinician-established attribution; assessor and date Separates the symptom from claims about what causes it.
- Care and response
- Links to assessments or interventions, exposure dates, reported benefit, adverse effects and uncertainty Supports continuity without assuming that a change following care was caused by that care.
Also called
Where this came from
wikidata · CC0 1.0
Drafted structure
Bundle to layer to finding to question, as the second pass will find it: 5 bundles · 9 layers · 17 findings · 25 questions.
Pain presentation Defines where the pain is experienced and how the current episode developed.
Lower back pain must be recognised from the reported presentation without prematurely assigning an anatomical cause.
Location and spread
Records the lower back area and distinguishes it from accompanying pain elsewhere.
Reported pain distribution
Capture the person's indicated pain area, laterality and spread, retaining uncertainty at boundaries with flank, pelvic or hip pain.
- Where does the person indicate the pain, and does that area include the lower back? boundary
- Does pain spread into the buttock or leg, and what is its reported route and furthest extent? measurement
Episode and course
Separates onset, continuous symptoms, fluctuations and recurrence.
Episode timeline
Record onset, any reported precipitating event, prior episodes and intervening recovery without equating temporal association with cause.
- When did this episode begin, how certain is that date, and what changes have occurred since? provenance
- Were there earlier episodes and periods of recovery, and which explicit convention is used if a duration label is assigned? definition
Pain burden and function Captures symptom burden, activity limitations and the person's recovery priorities.
Similar pain reports can have very different practical consequences, so intensity and function need separate records.
Intensity and variation
Makes pain reports comparable across time and activity contexts.
Contextual pain measurement
Record the scale, anchors, recall period and circumstances of each intensity report, including aggravating or easing activities as reported observations.
- What intensity is reported using which scale, anchors and recall period? measurement
- How does the report vary with sitting, standing, walking, bending, rest or time of day? measurement
Daily life and goals
Records effects on sleep, movement, self-care, work and participation.
Activity interference and priorities
Describe what the person can do, avoids or needs assistance with, and identify meaningful activities they want to regain.
- Which everyday tasks or sleep activities are affected, and how are those limitations measured? measurement
- Which activity would the person most like to regain, and what observable change would count as progress? action
Assessment and attribution Separates associated symptoms, assessment priority and evidence about possible causes.
A lower back pain model must preserve uncertainty while supporting appropriate human assessment through an approved clinical pathway.
Associated symptoms and priority
Records information required by a selected assessment pathway without treating an isolated answer as a diagnosis.
Pathway-relevant observations
Preserve timing and assessment status for neurological changes, bladder or bowel changes, saddle-area sensory changes, systemic symptoms, trauma and relevant medical history; interpretation belongs to a sourced pathway.
- What associated symptoms or history have been reported or assessed, when did they arise, and which items remain unknown? provenance
- Under the applicable approved pathway, what human review is indicated, within what timeframe, and has that review occurred? action
Clinical interpretation
Links possible explanations to their evidence and responsible assessor.
Attribution and evidence
Keep person-reported explanations, examination observations, investigation results and clinician interpretations distinct, including disagreement or unresolved attribution.
- Who proposed any cause or clinical classification, on what date, and using what evidence? provenance
- Which explanations remain suspected or unresolved, and which require a linked disease model rather than expansion of this symptom model? boundary
Context, care and reassessment Records circumstances affecting daily management, care received and changes that require review.
Decisions depend on the person's circumstances and observed course, as well as on the location and severity of pain.
Participation and care context
Captures work demands, support, beliefs and access constraints without assigning blame or unsupported causation.
Barriers and supports
Record relevant lifting or posture demands, opportunities to adapt activities, concerns about movement and practical access to care as contextual observations.
- Which work, household or caregiving demands constrain the person's ability to manage the episode? provenance
- What concerns, preferences, available support or access barriers should an authorised care discussion address? action
Response and follow-up
Connects care exposure to repeated outcome observations and an explicit review plan.
Care response and review plan
Record care actually received, reported benefits or harms, changes in function and the responsible person's reassessment plan without inferring treatment effectiveness from timing alone.
- What care was received and when, and how did pain, function or adverse experiences change using comparable observations? measurement
- Who owns follow-up, when is review planned, and what changes trigger earlier contact under the agreed care pathway? action
Evidence and external alignment What the world already says about this thing, gathered so the model can be checked against it.
A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.
Reported evidence
Findings from the breadth pass, kept separate from the structural claims.
Check these first
Recalled without web access and unsourced; every item is a lead to verify.
- This is a recall-based description; no sources were consulted.
- Duration thresholds vary between guidelines, and the listed kinds overlap rather than form mutually exclusive categories.
- Verify current coding editions and guideline scope; chronic primary low back pain is not interchangeable with every form of chronic low back pain.
- Which of these check these first hold for the sense of lower back pain this model covers, and on what evidence? provenance
Kinds and varieties
Recalled without web access and unsourced; every item is a lead to verify.
- Nonspecific low back pain, without a reliably identified specific cause
- Low back pain attributable to a specific disease or structural lesion
- Low back pain with radicular pain or radiculopathy
- Acute low back pain
- Subacute low back pain
- Chronic low back pain
- Which of these kinds and varieties hold for the sense of lower back pain this model covers, and on what evidence? provenance
Identifiers and schemes
Recalled without web access and unsourced; every item is a lead to verify.
- ICD-10, World Health Organization - M54.5 - Low back pain in the WHO classification; national modifications and current billing editions can use different or more detailed codes.
- Medical Subject Headings (MeSH) - Low Back Pain - Controlled vocabulary descriptor used to index biomedical literature.
- Which of these identifiers and schemes hold for the sense of lower back pain this model covers, and on what evidence? provenance
Standards and regulation
Recalled without web access and unsourced; every item is a lead to verify.
- World Health Organization guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings
- NICE guideline NG59: Low back pain and sciatica in over 16s: assessment and management
- American College of Physicians clinical practice guideline on noninvasive treatments for acute, subacute, and chronic low back pain
- Which of these standards and regulation hold for the sense of lower back pain this model covers, and on what evidence? provenance
Real-world use
Recalled without web access and unsourced; every item is a lead to verify.
- Clinical assessment distinguishes nonspecific symptoms from neurological involvement and specific underlying disease.
- Rehabilitation uses pain, function and participation measures to assess progress.
- Occupational health evaluates effects on work capacity and possible workplace adjustments.
- Epidemiological studies estimate prevalence, disability and healthcare burden.
- Clinical trials compare treatments using pain intensity, disability and other patient-reported outcomes.
- Which of these real-world use hold for the sense of lower back pain this model covers, and on what evidence? provenance
Typical measurements
Recalled without web access and unsourced; every item is a lead to verify.
- Pain intensity using a numerical rating scale - 0-10; instrument bounds, not an expected patient range - score
- Disability using the Oswestry Disability Index - 0-100; higher scores indicate greater disability - %
- Disability using the Roland-Morris Disability Questionnaire - 0-24 for the original questionnaire; higher scores indicate greater disability - score
- Symptom duration - Common conventions: acute under 6 weeks, subacute 6-12 weeks, chronic over 12 weeks - weeks
- Which of these typical measurements hold for the sense of lower back pain this model covers, and on what evidence? provenance
Failure modes and hazards
Recalled without web access and unsourced; every item is a lead to verify.
- Misclassifying serious causes such as vertebral fracture, infection or malignancy as nonspecific pain.
- Missing cauda equina syndrome or progressive neurological impairment.
- Attributing symptoms to incidental imaging abnormalities without clinical correlation.
- Persistent pain, reduced activity, disability and work loss.
- Treatment-related harm, including medication adverse effects and complications of unnecessary procedures.
- Which of these failure modes and hazards hold for the sense of lower back pain this model covers, and on what evidence? provenance
Regional variation
Recalled without web access and unsourced; every item is a lead to verify.
- Diagnostic coding differs between WHO ICD editions and national clinical modifications.
- Access to rehabilitation, multidisciplinary care and occupational support varies across health systems.
- Imaging, prescribing and procedural practice varies with local guidelines and healthcare arrangements.
- Which of these regional variation hold for the sense of lower back pain this model covers, and on what evidence? provenance
Neighbouring kinds and how to tell them apart
Recalled without web access and unsourced; every item is a lead to verify.
- Sciatica - Describes radiating leg pain associated with lumbosacral nerve-root involvement; lower back pain can occur without it.
- Lumbar radiculopathy - Involves nerve-root dysfunction with neurological deficits such as weakness, sensory loss or altered reflexes; pain alone does not establish it.
- Lumbar disc herniation - An anatomical abnormality that may cause symptoms or be asymptomatic; it is not synonymous with lower back pain.
- Axial spondyloarthritis - An inflammatory disease that can cause lower back pain but requires evidence beyond the location of pain.
- Which of these neighbouring kinds and how to tell them apart hold for the sense of lower back pain this model covers, and on what evidence? provenance
What the second pass must settle
- Which anatomical definition should govern the lower back boundary, and how should ambiguous flank, pelvic or hip descriptions be represented?
- Which duration and recovery conventions should distinguish acute, persistent and recurrent episodes across the intended settings?
- Which current, jurisdiction-appropriate assessment pathways should govern escalation, and what actions may the intended agent perform?
- Which pain and functional measures are appropriate for the intended populations, languages and accessibility needs, and what changes are meaningful to those users?
- How should differing clinical uses of nonspecific, primary, secondary and radicular classifications map to this entry and neighbouring disease models?