Back Pain Flashcards
The location of back pain is usually related to the region of the vertebral column.
Low back pain (… region)
Mid-back pain (… region)
Upper back pain or neck pain (… region)
Low back pain (lumbar region)
Mid-back pain (thoracic region)
Upper back pain or neck pain (cervical region)
The vast majority of back pain is located in which region?
The vast majority of back pain is located in the lower lumbar region known as low back pain
The onset of back pain can be broadly divided based on acuity.
Acute: back pain < … weeks
Subacute: back pain for .. - .. weeks
Chronic: back pain for ≥ … weeks
Acute: back pain < 4 weeks
Subacute: back pain for 4 - 12 weeks
Chronic: back pain for ≥ 12 weeks
The causes of back pain can be broadly divided into musculoskeletal, non-musculoskeletal, and … ….
The causes of back pain can be broadly divided into musculoskeletal, non-musculoskeletal, and referred pain.
Back pain can be broadly divided into three categories:
Musculoskeletal (i.e. mechanical) Non-musculoskeletal (i.e. non-mechanical) Referred pain (i.e. from visceral organ)
Despite numerous possible causes, a significant proportion of adults (> 85%) will not have an identified cause of their back pain. This is often described as ‘…’ and usually resolves within …
Despite numerous possible causes, a significant proportion of adults (> 85%) will not have an identified cause of their back pain. This is often described as ‘non-specific back pain’ and usually resolves within a few weeks.
Musculoskeletal (mechanical) back pain causes (9)
Muscular Degenerative discs Spondylosis Spondylolisthesis Spinal fracture Spinal stenosis Scoliosis Sacroiliitis Radiculopathy
Muscular back pain:
Strain or sprain within the paraspinal lumbar muscles accounts for a significant proportion of low back pain. Often leads to intense pain for 24-48 hours. A strain is an injury to a muscle(s) or muscle-tendon(s) and a sprain is an injury to a ligament(s)
Degenerative discs - back pain
herniation or bulging of the intervertebral discs can lead to back pain and discomfort. If the disc impingements on nerve roots it can lead to radicular pain (i.e. shooting pain along a nerve root) that passes into the leg.
Spondylosis (i.e. osteoarthritis of the spine): this refers to …
this refers to degenerative arthritis affecting the spine that can cause aching, pain, or stiffness in the back
Spondylolisthesis: this refers to …
this refers to one of the vertebral bones slipped out of alignment. It may be related to degenerative changes, trauma, or a stress fracture in the bone known as spondylolysis
Spinal stenosis: this describes …
this describes narrowing of the spinal canal. Typically multifactorial due to spondylosis, spondylolisthesis, and/or ligament changes (e.g. ligamentum flavum hypertrophy). Classically causes back pain and lower limb claudication (i.e. leg pain/cramping on movement). The pain is differentiated from vascular lower limb claudication by the presence of paraesthesia-type pain that is worse with the back extended (e.g. going downhill) and relived on sitting/lying within minutes not immediately.
Scoliosis: this refers to ..
this refers to lateral curvature of the spine.
Sacroiliitis: this refers to …
this refers to inflammation of the sacroiliac joints that are commonly seen in ankylosing spondylitis. It is characteristically worse in the morning and better with exercise.
Radiculopathy: refers to …
refers to symptoms or impairments related to the involvement of a spinal nerve root. Classically causes back pain and radicular pain felt in the distribution of the spinal dermatome.
back pain in association with malignancy is commonly due to …
back pain in association with malignancy is commonly due to metastasis to the spine.
As cancer deposited within the spine continues to grow it may damage surrounding structures lead to spinal instability and can lead to … compression or … … syndrome. Pain may also be from a primary boney tumour or s….
As cancer deposited within the spine continues to grow it may damage surrounding structures lead to spinal instability and can lead to cord compression or caudal equina syndrome. Pain may also be from a primary boney tumour or sarcoma.
Epidural abscess: this may cause localised pain and fever. Depending on the size it may compress nerve roots leading to … or the spinal cord causing …. Usually, there is a history of an epidural, spinal injection, or adjacent soft tissue infection.
Epidural abscess: this may cause localised pain and fever. Depending on the size it may compress nerve roots leading to radiculopathy or the spinal cord causing compression. Usually, there is a history of an epidural, spinal injection, or adjacent soft tissue infection.
Discitis: this refers to an infection of the intervertebral disc and is commonly due to a … infection. Commonly associated with iatrogenic line infections or endocarditis. Causes localised back pain.
Discitis: this refers to an infection of the intervertebral disc and is commonly due to a Staphylococcal infection. Commonly associated with iatrogenic line infections or endocarditis. Causes localised back pain.
…: this refers to infection of the bone. Typically causes gradually worsening pain over weeks in association with fever and other constitutional symptoms. Many cases are healthcare-related due to bacteraemia following a procedure.
Osteomyelitis: this refers to infection of the bone. Typically causes gradually worsening pain over weeks in association with fever and other constitutional symptoms. Many cases are healthcare-related due to bacteraemia following a procedure.
… arthropathy: many connective tissue disorders can affect the musculoskeletal structures of the spine leading to back pain.
Inflammatory arthropathy: many connective tissue disorders can affect the musculoskeletal structures of the spine leading to back pain.
Pain felt in the back may be referred pain from a visceral organ. Some of these causes can be life-threatening so it is important to have a high index of suspicion. Classic examples include: (6)
Pancreatitis Aortic dissection Renal calculi Ruptured aortic aneurysm Pyelonephritis Biliary colic
Pancreatitis Aortic dissection Renal calculi Ruptured aortic aneurysm Pyelonephritis Biliary colic
Can all cause pain where?
Back pain
It is essential to exclude … or …. in patients with back pain.
It is essential to exclude spinal cord or cauda equina compression in patients with back pain.
In simple terms, back pain with new neurological features may suggest spinal cord or cauda equina involvement and a full neurological examination with an inquiry about …/… function is essential.
In simple terms, back pain with new neurological features may suggest spinal cord or cauda equina involvement and a full neurological examination with an inquiry about bladder/bowel function is essential.
Spinal cord compression
This refers to compression of the spinal cord anywhere along its course from the … magnum to the L../.. vertebrae. Spinal cord compression is commonly due to metastatic cancer or mechanical causes (e.g. unstable spinal fracture).
Spinal cord compression
This refers to compression of the spinal cord anywhere along its course from the foramen magnum to the L1/2 vertebrae. Spinal cord compression is commonly due to metastatic cancer or mechanical causes (e.g. unstable spinal fracture).
Back pain is often the presenting feature. Cord compression is characterised by: (5)
Back pain (usually symmetrical and bilateral) Bilateral leg weakness Increased reflexes (upgoing planters, increased knee reflex) Sensory level (the lowest spinal cord level that still has normal pinprick and touch sensation. Below this there is abnormal sensation. The level corresponds to the dermatomes) Bladder/bowel dysfunction (late sign)
Cauda equina syndrome - what is this?
This refers to compression of the cauda equina, which describes the collection of spinal nerves composed of lumbar, sacral, and coccygeal nerves beyond the terminal part of the spinal cord. Cauda equina syndrome is commonly due to malignancy or mechanical causes (e.g. disc disease, trauma).
Caudal equina syndrome is characterised by:
Back pain (more asymmetrical and radicular)
Asymmetrical leg weakness
Reduced reflexes (downing planters, absent knee reflex)
Radicular sensory loss (dermatomal pattern)
Urinary retention
Reduced anal tone
Saddle anaesthesia
What is saddle anaesthesia?
Saddle anaesthesia refers to reduced sensation in the area that would be in contact with a saddle if sitting on one.
When evaluating back pain it is important to consider the …
When evaluating back pain it is important to consider the mechanism of injury.
Constitutional symptoms - back pain
Fatigue Fever Weight loss Night sweats Myalgia/Arthralgia Anorexia
They are associated with systemic diseases such as an underlying infection, inflammatory disorders, or cancer.
