Back Pain

Question 1

Common causes of back pain?

Answer 1

-Osteoarthritis
-Osteoporosis
-Slipped Disk
-Muscle Strains
-Hip or Joint Issues
-Sciatica Flare-Ups

Question 2

T or F: NSAIDs are excellent OTC medications for Sciatica.

Answer 2

FALSE (!!!)… Neuropathically originating pains NSAIDs are shit.

Question 3

Factorial things that may bring about acute back pain flare-ups?

Answer 3

-Sedentary
-Activity Bursts
-Improper Lifting
-Pregnant
-Posture
-Shoes Shit
-Fat

Question 4

What’s a Pharmacist’s role in terms of treating back pain & giving advice?

Answer 4

Very little… Advice on safe med use & suggest “seeing Physio or Massage Therapists & potentially MD if severe enough pain”.

Question 5

What sorts of differential questions are we good to ask for back pain that wouldn’t be malpractice?

Answer 5

-How long & how bad is pain?

-Location (lower or upper?)

-Due to fall or slip?

-Numbness in butt area?

-Acute weight loss / fever / chills?

Question 6

Pain located in the upper back results in what?

Answer 6

Automatic Referral… Could be indicative of something greater (ie. Osteoporosis or Osteoarthritis).

Question 7

Rule of thumb for back pain referrals on our end is what length of time?

Answer 7

5d (with no relief of general back pain)

Question 8

Is recommending a patient to jump into back stretches & exercising a good idea after an acute back pain episode?

Answer 8

NO (!!!)… This is malpractice! Referral to a specialist is warranted & we have no grounds to talk about these things (outside of our scope of practice).

Question 9

At standard OTC doses, is Acetaminophen providing anti-inflammatory effects for back pains?

Answer 9

Nope… Analgesic yes, but AI nope.

Question 10

What would be a better 1st line OTC treatment for back pains than Ace (given its shitty AI effects at OTC dosing)?

Answer 10

Voltaren Emugel (then Ibu or Nap)

Question 11

At doses of up to 4g / day, does ASA demonstrate AI effects?

Answer 11

Yep

Question 12

At OTC dosing, does Ibu or Nap demonstrate AI effects for those with back pain?

Answer 12

NOPE (!!!)

Question 13

Are Skeletal Muscle Relaxants beneficial for those with back pain?

Answer 13

Meh… Sedative effects but notoriously non-effective for back pain & demonstrate anti-cholinergic s/e’s that are undesirable (ie. Dry Mouth).

Question 14

Is Methocarbamol clinically effective for back pains?

Answer 14

Not really… Along for the ride with Ace & has demonstrated drug abuse risk factors too (b/c it provides a buzz).

Question 15

For the 1st 48hrs-5d, is heat or cooling recommended for acute back pain flare-ups?

Answer 15

Cold ; Recurrent more so Heat (as it’s anti-spasmodic)!

Question 16

Topical Analgesics act as a ________ for back pain.

Answer 16

counter-irritant

Question 17

What are the main agents in topical analgesic products?

Answer 17

Methyl Salicylate & Menthol (>1% to act as counter-irritant)

Question 18

What Rub-A535 agent is suitable for those who want odorless topical analgesics?

Answer 18

Triethanolamine (odorless)

Question 19

Can I use heat pads with Icy-Hot products?

Answer 19

NOOOOOOO

Question 20

Zostrix contains what ingredient (Substance P depletion)?

Answer 20

Capsaicin

Question 21

Active Ingredient in Voltaren?

Answer 21

Diclofenac

Question 22

Why is Voltaren Emugel a suitable product for those over the age of 75?

Answer 22

-Less systemic s/e’s than oral NSAIDs

Question 23

What spice may provide some arthritic relief?

Answer 23

Turmeric

Question 24

Are back braces a good move?

Answer 24

Only for heavy lifting… Cinched up chronically (after only 2-3wks) can actually weaken the back muscles & make pains worse!

Question 25

Next step up from regular analgesics?

Answer 25

Cyclobenzaprine (should be used only for 2-3wks at a time)

Question 26

Anti-Depressants any good for back pain?

Answer 26

Not great