B6-033 Acute Lower Back Pain

Question 1

saddle anesthesia
loss of anal sphincter tone
significant motor deficits encompassing major nerve roots

red flag symptoms of

Answer 1

cauda equina syndrome

Question 2

significant trauma relative to age
prolonged corticosteroid use
age > 70

risk factors for

Answer 2

fracture

Question 3

spinal procedure in the last 12 months
fever, wound in spinal region
Iv drug use, immunosuppression

red flag symptoms of

Answer 3

infection

Question 4

history of metastatic cancer
weight loss, focal tenderness/pain

red flag symptoms of

Answer 4

malignancy

Question 6

lack of full spine ROM can indicate

Answer 6

ankylosing spondylitis

Question 7

physical exam for acute low back pain should include

Answer 7

ROM
midline/spinous process tenderness
lower extremity motor, sensory, and reflexes
straight leg test

Question 8

are imaging studies necessary for nonspecific lower back pain without red flag symptoms?

Answer 8

no

Question 9

best nonpharmacologic intervention for acute lower back pain

Answer 9

heat

Question 10

while exercise has not been found beneficial in back pain, […] is important to recovery

Answer 10

maintaining daily activities level

Question 11

most effective pharmacologic therapy

Answer 11

NSAIDs

Question 12

90% of patients recover within […]

Answer 12

6 months

50-75% resolve at 4 weeks
reassurance about recovery can be helpful

Question 13

[…] is common
50% within 6 months
70% within 12 months

Answer 13

recurrence

counsel patient on things to look out for

Question 14

risk factors for acute to shift to chronic back pain [4]

Answer 14

psychiatric disorders
maladaptive coping
functional impairment
poor health

Question 15

describe the duration of acute, subacute, and chronic lower back pain

Answer 15

acute: <4 weeks
subacute: 4-12 weeks
chronic: 12+ weeks

Question 16

risk factors for acute lower back pain

Answer 16

obesity
sedentary lifestyle
age >30
arthritis
osteoporosis
smoking
pregnancy
psychiatric conditions
poor posture
occupational exposures

Question 17

a recent diagnosis of cancer raises concern for

Answer 17

spinal metastases

Question 18

urinary/bowel incontinence and saddle anesthesia are red flag symptoms for

Answer 18

cauda equina syndrome

Question 19

immunosuppression, fever, bacteremia, IV drug use are red flag symptoms for

Answer 19

infection

Question 20

advanced age and mild trauma are red flag symptoms for

Answer 20

fracture

Question 21

[…] imaging is indicated in acute lower back pain with no red flags

Answer 21

no

Question 22

when is X ray indicated for acute lower back pain?

Answer 22

when there are red flag symptoms of for vertebral fracture, cancer metastases, ankylosing spondylitis

Question 23

when is MRI indicated for acute lower back pain?

Answer 23

when there is red flag symptoms for vertebral abscess or cauda equina syndrome

Question 24

[…] has the most evidence for nonpharmacologic pain relief

Answer 24

heat

Question 25

is physical therapy helpful for acute back pain?

Answer 25

no

may be helpful to prevent recurrence though

Question 26

[…] have the best evidence for pharmacologic pain relief

Answer 26

NSAIDs

Question 27

second line medications that can be added to an NSAID if pain persists

Answer 27

muscle relaxants (cyclobenzaprine)