Back Pain Flashcards
What can cause back pain?
- Mechanical pain
- Fracture
- Malignancy
- Infection
- Inflammation
- Autoimmune conditions
What can cause mechanical back pain? (4 answers total)
- Lumbar strain/sprain of muscles
- Bulging/herniated intervertebral disc
- Spinal stenosis
- Facet joint disease (osteoarthritis)
What can aggravate mechanical back pain?
Certain movements and postures
What percentage of missed work days in the UK are attributed to back pain?
40%
Define Spondylosis
Stress fracture of the pars interarticularis
What are the features of spondylosis?
- Mild lumbar pain
- Common in sports people
- Limited cause of disability
Define Spondylolisthesis
‘Slipped disc’ - the intervertebral disc becomes slipped in-between the vertebra.
What are the features of spondylolisthesis?
- acute or insidious onset
- Nerve root symptoms
- Step deformity
- Pain on back extension
- Tender paraspinal musculature
What Cancers commonly metastasise to bone?
Kidney - Kinds Ovarian - Of Thyroid - Tumours Lung - Leaping Prostate - Promptly Testicular - To Myeloma - My Breast - Bone
What sort of back pain will be a red flag for malignancy?
Thoracic back pain
Back pain on waking
Back pain that wakes from sleep
What are the rarer forms of bone cancer?
- Chondrosarcoma
- Sarcoma
What 3 infections can commonly cause back pain?
- Discitis
- Osteomyelitis
- TB
What percentage of the UK population complain of back pain within their lifetime?
60-80%
What is the main cause of back dominant pain?
Being a walking mammal, causes pain in the back occasionally
What is the main cause of leg dominant back pain?
A disc problem is the main cause of this as it puts pressure on the nerve roots in the vertebral column. This is often improved on lying flat
What sort of back and leg pain improves on moment and worsens on sitting?
Neurogenic claudication
What is so important to encourage in patients with back pain?
MOVEMENT is key! Ensure the patient keeps moving with the back pain, provide analgesia.
List back pain RED FLAGS
- Altered bowel/bladder habit (Cauda Equina)
- Saddle paraesthesia (Cauda Equina)
- Change in sensation in the legs/pelvic area (Cauda Equina)
- Pyrexia (Sepsis?)
- IV drug user or immunocompromised patient with septic signs and back pain
- Fall induced back pain - osteoporosis?
- ANY Cancer red flags - weight loss, night sweats, loss of appetite
What are yellow flags in back pain patients?
Think of the patients’ attitudes towards their back pain, including their beliefs, attitudes and emotions. This includes the way the patient is supported by friends, family and their workplace.
What is the STarT back Keele screening tool?
A questionnaire to be completed by the patient, asking them questions about their back pain and how it has been affecting them in the last 2 weeks. This will help us to understand how the patient perceives their medical state.
What score from the STarT back tool would classify a patient as ‘low risk’?
3 or less
What score from the STarT back tool would classify a patient as ‘Medium risk’? (sub score Q5-9)
3 or below
What score from the STarT back tool would classify a patient as ‘High risk’? (sub score Q5-9)
4 or more
List the symptoms of Cauda Equina Syndrome (6 total from CKS)
- Bilateral sciatica
- Severe or progressive bilateral neurological deficit of the legs
- Difficulty initiating micturition or impaired sensation of urinary flow, with later retention an overflow
- Loss of sensation of rectal fullness and later faecal incontinence
- Saddle anaesthesia or paraesthesia
- Laxity of the anal sphincter
List the symptoms of Spinal fracture (4 total from CKS)
- Sudden onset, severe pain, relieved by lying down
- History of trauma (may be a minor trauma in those with osteoporosis)
- Structural spinal deformity
- Point tenderness over a vertebral body
List the features of back pain caused by cancer (10 total - from CKS)
- > 50 years old
- Gradual onset
- Severe, unremitting pain
- Night pain which disturbs sleep
- Pain worse with straining/coughing/sneezing
- Thoracic pain
- Localised spinal tenderness
- No symptomatic improvement after 4-6 weeks of conservative back pain therapy
- Unexplained weight loss
- Personal Hx of cancer
List the features of a patient with back pain induced from an infection (5 from CKS)
- Fever
- TB or recent UTI
- Diabetes
- Hx of IV drug use
- HIV +ve, use of immunosuppressants or the person is immunocompromised
Where is the cauda equina?
L1
How do we assess the back?
LOOK
FEEL
MOVE
Why does a patient not need an X-Ray of their back commonly with back pain?
An X-Ray would not usually illicit much information about the cause of back pain - other than identifying a fracture. This also puts patients radiation exposure up unnecessarily.
What scan is appropriate to identify any soft tissue structural pathology in the back?
Soft tissue pathology is more obvious on MRI scanning, as well as identifying Cauda Equina Syndrome.
What are the 4 red flag conditions to be wary of with lumbar back pain?
- Cauda Equina Syndrome
- Cancer of the spine
- Spinal fracture due to trauma or osteoporosis
- Spinal infection
What intra-abdominal GI conditions can cause back pain?
- Pancreatitis
- Peptic ulcer
What GU conditions can cause back pain?
- Renal colic
- Pyelonephritis
- Prostatitis
- Pelvic infection
What are the 4 categories of medications that can be offered to a patient with back pain for analgesia?
- Diazepam
- NSAIDs
- Paracetamol
- Weak opioids
What is the recommended starting regime for diazepam in someone with lumbar back pain?
2mg up to TDS PRN with muscle spasm
How much can diazepam be titrated up to when treating lumbar back pain?
5mg TDS (up to)
How long can diazepam be prescribed for when someone has lumbar back pain?
Only a short course can be prescribed due to the addictive nature of benzodiazepines. The course can be between 2 and 5 days only.
