3 Intro To LBP

Question 1

Does LBP contribute to opioid epidemic?

Answer 1

Yes

Question 2

What is the prognosis for LBP patients?

Answer 2

Good

90% are better at 8 weeks
10% will have disabling chronic pain

Of the 90%

• 65% have 1 more episode within a year
• 33% experience moderate or intense pain intermittently or continuously at a year
• 20% report functional limitations long term

Question 3

When is LBP acute, subacute, chronic?

Answer 3

<1 month acute
4-12 weeks subacute
>3 months chronic

Question 4

What is the first step in DDX of NMS condition?

Answer 4

Is it injury or disease?

Question 5

What are 5 ways to injure your low back?

Answer 5

1. Repetitive microtrauma
2. Sustained, postural load
3. Single traumatic event
4. Sudden unguarded movement
5. Normal activity with unstable spine

Question 6

What are 6 non-specific mechanical back pain injuries?

And what are the 2 specific low back pain injuries?

Answer 6

Disc derangement
Extensor strain
Facet syndrome
Joint dysfxn
Myofascial pain syndrome
Sprain

Specific Injuries:

• Fracture
• Spondylolysis/spondylolisthesis

Question 7

What are 6 injury diagnosis that cause LBP and Neuro damage?

Answer 7

• lumbar disc herniation
• spinal canal stenosis
• fracture
• osteophytes compression of nerve
• nerve root adhesions
• spondylolisthesis or structural instability

Question 8

How do you manage patient communication around pain? (PAAP)

Answer 8

• Pain perception is not always related to presence or degree of physical damage
• Active, return to normal activities even if there is some pain. Pain does not mean more damage.
• ADLs. Focus on functionality day-to-day instead of pain
• Prognosis is favorable for pain relief and return of function though there may be flare-ups or recurrence

Question 9

What are first line therapy for pharmaceutical interventions?

Second line?

Answer 9

NSAIDS, anti-inflammatory
Paracetamol, analgesic
Muscle relaxant

Then: low-dose narcotic like tramadol

Question 10

What do guidelines do?

Answer 10

They make recommendations based off RCTs and meta analysis

Question 11

What are the 5 tool boxes to conservative management of patients?

Answer 11

Patient education (PAAP)
Chiropractic Manipulative Therapy (CMT)
Soft Tissue Manipulation (STM)
Behavioral Modification
Exercise therapy

Question 12

Examples of CMT?

Answer 12

Joint manipulation
Flexion-distraction therapy
Muscle injury technique (MET)

Question 13

STM examples?

Answer 13

PIR
CRAC
IASTM
Pin & Stretch
Cross fiber

Question 14

What are examples of exercise therapy?

Answer 14

Stretching and strengthening exercises
Core motor control/stabilization exercises
Yoga
Tai chi

Question 15

When chronic LBP is associated with what indications does the treatment end up being more challenging with a poorer prognosis?

Answer 15

Central sensitization
Psychological overlay

Because the nervous system is so se