Back Pain

Question 1

How does mechanical back pain present?
What are common causes of it?

Answer 1

Worse with movement
Better or not present at rest
Common causes: muscle spasms, disc disease, osteoarthritis of spine

Question 2

What is sciatica and what commonly causes it?

Answer 2

Pain radiating down leg
Disc herniation touching nerve root

Question 3

What are serious causes of back pain?

Answer 3

Metastatic cancer or myeloma
Infection: osteomyelitis, discitis, staphylococcus, TB
Ankylosing spondylitis
Fracture
Large disc prolapse

Question 4

What are red flag back pain symptoms?

Answer 4

Pain when lying down or sleeping
Constant progressive pain
Thoracic pain
Weight loss
Previous malignancy
Night sweats
Immunosuppressed
Bladder disturbance
Leg weakness or sensory loss

Question 5

What is cauda equina syndrome?
How does it present?
What are the investigations?

Answer 5

Compression of cauda equina
MEDICAL EMERGENCY CAN CAUSE PARALYSIS
Symptoms: saddle anasthaesia, bladder incontinence, loss of anal tone, radicular leg pain,
MRI SPINE

Question 6

What is the treatment for low back pain without red flags?
Are x-rays done?

Answer 6

Time
NSAIDS
Avoid bed rest
Physio
No, monitored for 3-4 weeks and reanalysed

Question 7

What blood tests can be done for back pain if worried and what will be seen?

Answer 7

FBC- increased WCC in infection
Increased ESR and CRP in myeloma and infection
Increased Calcium in metastases

Question 8

What are the treatments for herniated discs?

Answer 8

Nerve root injection- analgesia and glucorticoid
NSAIDS
Physio
Surgery if symptoms persist