5: Back pain MDT Flashcards
What common health problem puts a lot of strain on the spine?
Obesity
Where is localised back pain usually found?
Lumbar spine
What is a common form of referred back pain?
Sciatica (L4-S3)
Back pain often affects a patient’s ability to ___ and ___.
sleep , work
What should be asked about pain when taking a history?
SOCRATES
What should be asked about loss of function while taking a history?
ICE - how does it affect your daily life; ability to work?
Patients with back pain should be asked about past ___ and ___ in their medical history.
trauma , surgery
Back pain may be due to pathology in other ___.
systems
If there’s concern that a patient has inflammatory back pain, what tests should be carried out?
Blood test - inflammatory markers, calcium, ALP
Why are X-rays rarely carried out for people with back pain?
Lots of irrelevant details which can throw you
What scan is better at picking up spinal pathology and is carried out by specialists?
MRI scan
As a GP, in which cases would you request an:
a) X-ray
b) MRI scan
along with secondary referral for a patient presenting with back pain?
a) Red flag symptoms, trauma and/or osteoporosis
b) Non-resolving sciatica > 4 weeks and/or neurogenic claudication
What is the mnemonic used to remember X-ray changes in osteoarthritis?
Loss of joint space
Osteophytes
Sclerosis
Subarticular cysts
Most back pain is (mechanical / inflammatory).
mechanical
Some back pain can be caused by inflammatory conditions such as?
Ankylosing spondylitis
Can back pain be caused by infection?
Yes
Generally, what are the yellow flags for chronic back pain?
Social / behavioural factors which impede their recovery
What is the key principle when managing patients with back pain?
Don’t hurt them
What percentage of patients with back pain are dealt with in general practice?
80-90%
What percentage of orthopaedic referrals are for back pain?
20%
What government system has a big impact on the way patients deal with their back pain?
Benefit system
The longer (in months) a patient is off work with back pain, the (lower / higher) their chances of returning to work.
lower
What model is used in the management of patients with back pain?
Biopsychosocial model
What are the two most significant factors deciding the outcome of patients with back pain?
Accident at work with litigation
Psychological issues following it
this is regardless of diagnosis, surgery or patient factors
Which percentage of patients referred to orthopaedics with back pain are actually operated on?
2.5%
Findings of scans must be ___ to the presentation of the patient.
related
Most prolapsed discs, if given time, will settle without surgery. When is surgery considered?
After 3 months when the patient has been off work for too long
5/10 years later, are there any differences between the outcomes of disc prolapse patients who were operated on vs those who weren’t?
No
People with which spine pathology tend to have claudication?
Spinal stenosis
How do people relieve the claudication of spinal stenosis?
Flexion (lean forward)
Spinal stenosis patients have difficulty walking downhill - why?
Claudication relieved by flexing
Spine extends when we go downhill - exacerbates claudication
What activity do people with spinal stenosis find quite easy?
Cycling
How is
a) vascular claudication
b) spinal claudication relieved?
a) Rest
b) Flexion of spine
How do patients with intermittent vascular claudication find uphill walking?
Spinal claudication patients experience walking up hill differently - why?
Painful - due to muscle ischaemia
Fine - when they walk uphill their spine tends to be flexed
Walking (uphill / downhill) exacerbates spinal claudication.
Downhill - because spine is EXTENDED
How are disc prolapse and spinal stenosis treated?
Decompression / Discectomy / Stabilisation by fusion
Discogenic pain is (better / worse) on flexion.
worse
Remember that spinal stenosis is better on flexion
If facet joints are fused together to treat facet arthropathy, what disease can follow?
Adjacent segment disease
i.e facet arthropathy above and below due to presence of foreign material
