Back Pain Flashcards
1
Q
What is MBP?
A
- Pain that arises from the spinal joints, vertebrae or soft tissues
- characteristically exacerbated by movement.
2
Q
What causes BP?
* think the ones that are important for Y3
A
- non specific (most common)
- disc prolapse
- CES
- Spinal #
- Spondylodiscitis
- Metastasis
- Myelopathy
3
Q
What are the RF for BP?
A
- high demanding jobs
- poor manual handling
- obesity
- psychosocial work-related stress
- family history.
4
Q
What questions would you like to include in Hx for BP?
A
- Establishing when the pain started.
- Confirming whether pain was sudden or gradual in onset.
- Identifying the location of the pain.
- Enquiring whether there is pain radiation to anywhere else.
- Establishing whether there are aggravating or relieving factors.
- Confirming whether the patient has had this problem previously.
- Noting the patient’s occupation, hobbies or sport.
- Noting past medical history. Steroid use, malignancy, myeloma.
- Asking the patient to confirm how they have been managing the condition
5
Q
How would you examine pt with BP?
A
- inspection, palpation, brief neurological examination and an assessment of function.
- More detailed neurological examination if red flags noted
- lasegue test
- ASIA chart
6
Q
What are the differential diagnosis of BP?
A
- spinal fracture
- cancer (myeloma, osteosarcoma)
- infection (osteomyelitis, TB, Pyelonephritis)
- Inflammatory (AS, PA, RA)
- Bone disorders (Paget’s disease, Osteoporosis, Spinal stenosis)
- prolapsed intervertebral disc
- Others (dissecting aorta, nephorlithiasis, pyelonephritis, duodenal ulcer)
7
Q
Cancers metastasing at vertebrae arise from?
A
- Lung.
- Breast.
- Prostate.
- Thyroid.
- Kidney.
8
Q
How would you Mx BP?
A
Conservative
- Give information, reassurance and advice.
- Advise the patient to stay as active as possible.
- CBT
- Physio
Medications
- NSAID (first line)
- Codeine +/- paracetamol if NSAID contraindicated
- Paracetamol monotherapy has been shown to be ineffective and should not be recommended
9
Q
When to refer LBP?
A
- Presence of red flags
- progressive, persistent or severe neurological deficit
- Pain persist for 1-2weeks, early referral to physio
- Pain persist for 6 weeks, refer to orthopaedic assessment
10
Q
What Ix would you order for back pain?
A
- If MBP > no ix required
Bloods & Urine
- FBC, ESR, CRP, urine analysis (if infection, inflammation or cancer suspected)
- LFT (elavated in Paget’s disease)
- PSA (if prostate cancer)
- Urinary hydroxyproline (Paget’s disease)
- Red cell cast (nephrolithiasis)
Imaging
- Lumbar x ray (only if fracture or mets suspected)
- CT (stress # and spondylolisthesis)
- MRI (nerve root compression, discitis, neoplastic disease)
11
Q
Why is lumbar xray not routinely offered for back pain?
A
- Provides the same dose of radiation as around 120 chest X-rays
- offers very limited information and rarely affects management.
12
Q
What are the red flag sx associated with back pain?
List for CES
A
- Saddle anaesthesia
- Painless urinary retention
- Recent onset of faecal and bladder incontinence (late sign)
- Unexpected laxity of the anal sphincter.
- Progressive bilateral neurological deficit of legs
13
Q
What are the red flag sx associated with back pain?
List for spinal fracture
A
- Sudden onset of severe central pain in the spine which is relieved by lying down.
- Major trauma such as a road accident or fall from a height.
- Minor trauma, or even just strenuous lifting, in people with osteoporosis.
- Structural deformity of the spine (such as a step from one vertebra to an adjacent vertebra).
- Point tenderness over the vertebral body.
14
Q
What are the red flag sx associated with back pain?
List for cancer
A
- 50 or older
- gradual onset sx
- aching night pain that distrubs sleep
- severe unremitting pain that remains when person is in supine
- localised spinal tenderness
- no sx improvement after 4-6weeks of conservative mx
- unexplained weight loss
- hx of cancer
15
Q
A
