19. Lombalgie Flashcards
Lombalgie - r/o causes graves (5)
- syndrome de la queue de cheval
- infx eg pyélonéphrite
- rupture d’anévrisme de l’aorte abdominale
- cancer
- fracture
lombalgie mécanique en phase aigue.. ne pas
surinvestiguer
conseils au pt lors d’une lombalgie mécanique (5)
- sx peuvent évoluer
- j’assure le suivi
- pronostic est favorable: majorité vont mieux
- consulter si sx de novo ou sx neuro
- discuter des stratégies pour prévenir les récidives
sx cord compression
Urinary/Fecal incontinence/retention, saddle anesthesia, motor weakness/numbness
eg lombalgie cause infx (3)
Discitis/epidural abscess/pyelonephritis
cause infx risk factors (65)
Fever,
IV drug use,
recent surgery,
recent infection,
immunocomprised
risk factors pour fracture 4
OP
steroid use
Age
trauma
Spondyloarthritis hx (11)
Improvement with exercise,
pain at night
(with improvement upon getting up/activity),
insidious onset,
age <40 years,
no improvement at rest,
fam hx
personal hx of inflam arthritis
enthesitis,
uveitis,
psoriasis
Radicular pain (Douleur radiculaire) sx (4)
et cause #1
2/2 disc herniation
leg pain,
sensory loss,
reduced reflex,
myotomal weakness
Neurogenic claudication is mostly 2/2
mostly 2/2 lumbar central spinal stenosis (LSS)
key features of neurogenic claudication
lumbar extension increases,
flexion decreases pain,
Bilateral buttock/thigh/leg pain, pseudoclaudication
lumbar pain other than MSK
Gyne
Renal (kidney stones)
GI
AAA
If mutiple red flags, investigations and conditions (5)
CBC, ESR (tumor, infection)
SPEP (multiple myeloma)
X-ray (fractures)
X-ray or CT Sacroiliac joints (ankylosing spondylitis)
+ HLA-B27 antigen (ankylosing spondylitis)
MRI (cauda equina)
Non pharma tx - acute or subacute
Superficial heat (moderate-quality evidence)
Massage, acupuncture, or spinal manipulation (low-quality evidence)
Maintain activity and re-assurance (95% improve in 6 weeks)
Pharmacologic treatment - acute or subacute
Topical NSAIDs
NSAIDs (eg. ibuprofen 600mg PO QID) or
skeletal muscle relaxants (eg. cyclobenzaprine 10mg PO TID) (moderate-quality evidence)
chronic low back pain - Nonpharmacologic treatment
Exercise***
multidisciplinary rehabilitation,
acupuncture,
mindfulness-based stress reduction
(moderate-quality evidence)
chronic low back pain - pharmacologic treatment
First-line: NSAIDs
Second-line
Rubafacients, eg. Capsaicin cream 0.025% topical QID
SNRIs, eg. Duloxetine 30-60mg PO daily
TCAs, eg. Amitriptyline 25mg PO daily
Gabapentinoids, eg. Gabapentin 300mg PO TID
radiculopathy vs radicular pain
Radiculopathy:
the whole complex of symptoms that can arise from nerve root pathology, including anesthesia, paresthesia, hypoesthesia, motor loss and pain.
Radicular pain and nerve root pain
a single symptom (pain) that can arise from one or more spinal nerve roots.
Différents niveaux: C7, T7, L4
C7 : most prominent cervical spine process
T7: inferior tip of scapula
L4 Sup aspect of iliac crest
