Back Pain Flashcards
Causes of back pain (NHS website)
Pulled muscle/strain
Slipped disc
Sciatica
Ankylosing spondylitis
Treatments
Painkillers (ibuprofen)
Physiotherapy
Manual therapy
CBT
Surgery
What is somatotropic arrangement?
Different areas of the body correspond to different areas of the somatosensory cortex of the brain
What is affective neuroscience?
Stimulation of different parts of the brain causes different effects
What can stimulation of the cingulate gyrus cause?
Aversion
What can stimulation of the insula cortex cause?
Vasoconstriction
Sweating
Increased pulse rate
What can stimulation of the amygdala cause?
Fear
What can stimulation of the reticular formation cause?
Arousal
Path of action potential for fine touch?
Sensory neurone via dorsal column-> medulla oblongata (decussation) via medial leminiscus-> thalamus -> sensory cortex
2 spinothalamic tracts?
Fast, sharp, a-delta fibres, often external pain and very precise (myelinated)
Slow, dull, C fibres, often internal pain
Fast spinothalamic tract route?
Receptor -> dorsal horn, decussates in spinal cord -> thalamus -> sensory cortex
Also connected to S II region (affects vision) and insula region (so causes vasoconstriction, sweating and increased pulse rate)
Slow spinothalamic route?
Receptor -> dorsal región (vía paleothalamic tract) -> decussates at spinal cord -> past reticular formation -> sensory + cingulate + amygdala
reticular - arousal
amygdala - fear
cingulate - aversion
Look at different brain regions mapped out
!!
Dorsal column sensations?
Fine touch, pressure, proprioception
Anterolateral column sensations?
Pain, temperature, light touch
Possible causes of medial posterior back pain?
- Vertebrae
- Spinal cord
- Nerve roots
- Lumbar muscles (e.g. erector spinae)
- Aorta
- Kidneys
- Pancreas
Science of referred pain?
Organs/viscera can synapse near skin dermatomes
At what level does the spinal cord end as an adult?
L1
How do spinal nerves get to the spinal cord if they are lower than L1?
Via the cauda equina
Radiculation?
Often due to disc herniation compressing spinal nerve
Unilateral
Cauda equina syndrome
L4/L5 and L5/S1 most common sites of nerve compression in CES
Disc herniation compressing cauda equina
Red flag symptoms of cauda equina syndrome?
Bilateral sciatica
Severe or progressive bilateral neurological deficit of legs (e.g. major motor weakness with knee extension, ankle eversion, or foot dorsiflexion
Difficulty initiating micturition or impaired sensation of urinary flow
Loss of sensation of rectal fullness
Perianal, perineal or genital sensory loss (saddle anaesthesia or paraesthesia)
Laxity of anal sphincter
Erectile dysfunction
Sympathetic nerves also known as?
Thoracolumbar (T1-L2)
cauda equina syndrome only affects below this level, so sympathetic activity will not be affected by the condition
Parasympathetic nerves also known as?
Craniosacral
CES can affect these levels, so PNS functions (like micturition and sexual function) can be affected by the condition
Sympathetic nervous system effect on bladder?
Relaxes detrusor muscle (so it can fill)
Contracts internal urethral sphincter (so urine cannot leave)
PNS effect on bladder?
Pelvic nerve from S2, 3 + 4
Contracts detrusor (so pushes out urine)
Relaxes urethral sphincter (so allows urine to leave)
sensory info also lost so unaware when need to urinate
Voluntary control of micturition
Pudendal nerve (supplying external sphincter) can also be affected by CES
Rare causes of CES?
Tumour
Infection
What is breach of duty?
the care provided by the doctor fell below a reasonable standard
What is causation?
the breach has caused loss or damage
Red flag symptoms legally
Pain that radiates below the knees bilaterally (on rare occasions this can be unilateral).
Bilateral lower limb numbness or weakness.
Numbness either side of the buttocks and saddle area.
Bladder and/or bowel disturbance (including difficulty passing urine, poor stream, loss of sensation).
Erectile dysfunction.
Loss of anal tone or impaired sensation on per rectal (PR) examination.
If no red flags, legally:
Make a record in the notes
Give safety net advice
