Back Pain

Question 1

Give 5 red flags in Back Pain

Answer 1

Aged 55
acute onset in the elderly
constant or progressive pain
nocturnal pain
worse pain on being supine
fever, night sweats, weight loss
history of malignancy
Abdominal mass
Thoracic back pain
morning stiffness
Bilateral leg pain
Neurological disturbance
Sphincter disturbance
infection
immunosuppression
leg claudication

Question 2

What are the 5 most likely causes of back pain in a patient aged 15-30 years?

Answer 2

Prolapsed disc, 
pregnancy,
 ankylosing spondylitis,
Trauma
Fractures

Question 3

What are the 3 most likely causes of back pain in a patient aged 30-50?

Answer 3

degenerative spine disease,
prolapsed disc
malignancy (primary or secondary)

Question 4

What are the 6 most likely causes of back pain in a patient aged over 50?

Answer 4

Degenerative
osteoporotic
vertebral collapse
Paget's
Malignancy (myeloma)
spinal stenosis

Question 5

In which patients with back pain should investigations be considered?

Answer 5

patients who have red flag symptoms

Question 6

What investigations hsould be considered in a patient with back pain and a red flag?

Answer 6

FBC, ESR, CRP, U+Es, ALP, PSA
Xray
~MRI for disc prolapse

Question 7

How should back pain be managed generally?

Answer 7

Look out for red flags
If red flag send for investigation dependant on age
If neurological deficit assoc. then send for urgent neurosurgical review
Deal with the pain, psychological and social issues
Consider physio and OT intervention