Pain from adjacent structures or referred pain

1. Kidney (e.g., pyelonephritis, perinephric abscess, nephrolithiasis).

2. Pelvic structures (e.g., pelvic inflammatory disease, ectopic pregnancy, endometriosis, prostatic disease).

3. Vascular (e.g., aortic aneurysm, mesenteric thrombosis).

4. Intestinal (e.g., diverticulitis).

H. Malignancy (involving any of the above structures). I. Miscellaneous conditions (e.g., sickle cell disease).

II. History. The history is of the utmost importance to obtain associated symptoms and establish a pattern of pain.

A. Associated symptoms. A thorough review of systems is required to establish concomitant symptoms that would suggest a nonmechanical cause of low back pain.

1. Fevers or chills would raise the possibility of an infectious process.

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