Back Pain

Question 1

red flags for back pain

Answer 1

1. <20Y, >50Y first time
2. trauma
3. constant and progressive
4. worse at night or supine
5. prev ca hx
6. IVDU, steroids, immunosupprants
7. fever +/- wt loss
8. neuro s/s

Question 2

yellow flags for chronic back pain

Answer 2

• belief that the back pain is harmful or potentially severely disabling
• fear avoidance behaviour: avoiding a movement of activity bc they think itll cause pain and reduced activity
• tendency for low mood adn withdrawal
• poor job satisfaction and hx of time off
• overprotective family or lack of support

Question 2

ddx for back pain

Answer 2

• cauda equina syndrome
• mechanical lower back pain ➔ soft tissue
• ankylosing spondylitis
• disc herniation
• lumbar spinal stenosis
• spinal infection
• tumour
• arthritis
• connective tissue disease
• referred pain
• fibromyalgia

Question 2

pharma tx for back pain

Answer 2

firstline: NSAIDs or Tylenol

consider: muscle relaxant (pill) or voltaren

opioids can consider
or epidural steroid injections

Question 3

gold standard for imaging for back issues

Answer 3

MRI!
can consider KUB for any urinary retention