Back Pain

Question 1

Risk factors (4)

Answer 1

Obesity
Physical inavtivity
Occuption - heavy lifter, twisting
Stressful life event

Question 2

Differentials

Answer 2

• mechanical back pain
• Prolapsed disc which may cause sciatica or cauda equina syndrome
• Piriformis syndrome (sciatic nerve compressed)
• Ankylosing spondylitis
• osteoporosis
• AAA
• stenosis (causes reduced arterial flow)
• Spondylolisthesis (displaced vertebral body)

Question 3

Associated symptoms of back pain - 8

Answer 3

morning stiffness
leg pain or weakness
muscle spasm
numbness
weight loss
Altered gait
Spinal deformity
Abnormal neuro exam on legs

Question 4

What are red flags for Cauda Equina Syndrome (5)

Answer 4

• sudden onset bilateral radicular leg pain
• perianal numbness
• Painless urinary retention
• ED
• incontinence

Question 5

What are red flags for spinal fracture (3)

Answer 5

history of trauma
severe central spinal pain and tenderness
structural deformity

Question 6

Red flags for spinal cancer

Answer 6

Gradual onset
severe lumbar pain
unexplained weight loss
PMH of cancer

Question 7

Management

Answer 7

Admission if they have any red flags
Advise paracetamol AND NSAIDS or codeine
Offer self help, physio, occupational health assessment.