Back Pain

Question 1

What are red flags for sinister causes of back pain?

Answer 1

<20 or >55, acute onset in elderly, constant/progressive pain, nocturnal pain, fever/night sweats/weight loss, history of malignancy, abdominal mass, thoracic back pain, morning stiffness, bilateral/alternating leg pain, neurological disturbance, sphincter disturbance, current/recent infection, immunosuppression, leg claudication/exercise-related weakness/numbness

Question 2

What can cause back pain in 15-30 year olds?

Answer 2

Prolapsed disc, trauma, fractures, ankylosing spondylitis, spondylolisthesis, pregnancy

Question 3

What can cause back pain in 30-50 year olds?

Answer 3

Degenerative spinal disease, prolapsed disc, malignancy

Question 4

What can cause back pain in patients over 50?

Answer 4

Degenerative, osteoporotic vertebral collapse, Paget’s, malignancy, myeloma, spinal stenosis

Question 5

What test would you do if there are red flag symptoms?

Answer 5

FBC, ESR, CRP, U&E, ALP, Serum/urine electrophoresis, PSA

Question 6

What is the first line imaging?

Answer 6

X-ray

Question 7

What is gold standard imaging?

Answer 7

MRI

Question 8

What is the first line management?

Answer 8

Normal activity and be active, paracetamol + NSAID if necessary + codeine if needed

Question 9

What else can be added?

Answer 9

Amitriptyline/duloxetine, physio, acupuncture, exercise programme