3 Back pain Flashcards
What happens to the intervertebral discs with age?
Lose water and strength, becoming thinner.
Repetitive loading causes annular tears.
What is the typical history of simple mechanical back pain?
First episode sudden onset, recurrent episode have increasing frequency.
Variable pain related to position/posture, better when lying down.
May radiate to buttock/leg.
Often worse at end of day.
What is the management for simple mechanical back pain? (3)
Pain relief options: (5)
Exercise.
No imaging.
Light duty options at work.
Simple analgesics: paracetamol, NSAIDs opioids, tricyclics, nerve modulators.
What is sciatica?
Signs? (5)
L4-S3.
Pain radiating from back of leg to below knee.
Ankle jerk and foot drop.
Associated with pins and needles, numbness and weakness.
What are red flag symptoms in back pain? (8).
Very young or old onset. History of carcinoma. Weight loss. 24 hr pain > 1 month. No treatment response. Pain worse at rest. History of IV drug use/HIV +ve. UTI.
What is the typical history of inflammatory back pain?
Insidious onset.
Nocturnal pain with early morning stiffness.
Better with exercise, worse with rest.
Family history of inflammatory conditions.
What are the symptoms of ankylosing spondylitis? (4).
Pain and stiffness of spine: fusion of sacroiliac joints.
Large joint oligoarthritis.
Enthesitis.
Iritis.
What is osteomalacia?
Vit D deficiency leading to bone thinning.
Simply, what is Paget’s disease of the bone?
Bone created in larger and abnormal quantities.
Raised ALP.
What are the typical symptoms of neoplastic back pain? (6).
Insidious onset. Slow deterioration. 24 hr pain. Weight loss. Associated symptoms. Fever.
What are the symptoms of neurogenic claudication?
Chronic back pain.
Bilateral leg symptoms: weakness, tingling, worse walking downhill.
What is cauda equina syndrome? (4)
Micturition difficulty.
Faecal incontinence/loss of sphincter tone.
Saddle anaesthesia.
Low back/leg pain.
