Back Pain Flashcards
Differentials for Back Pain? Skin Muscle Viscera Vascular Orthopaedic
Shingles Muscle Strain Fracture - spine or rib Infection - pyelonephritis, pancreatitis, TB, HIV AAA Duodenal Ulceration/Perforation Arthritis - OA, Psoriatic, Ankylosing Spondylitis Disc Herniation Sciatica Cauda Equina Malignancy -MM
How is the back pain in shingles?
Can present with just the pain
Unilateral
Can be pointed to
Dull, burning pain
Rash: Papular, erythematous rash, itchy, blistering
Hx of shingles and chicken pox
Can be post-viral/other infection
Treat with
Red Flags of Back Pain
Under 20 or over 55 Night pain Non-mechanical pain Thoracic pain Systemic Signs - night sweats, fever Weight Loss IVDU F/Hx of malignancy or infection Widespread Neuro Signs (Urinary incontinence)
Emergencies in Back Pain
Cauda Equina Malignancy Infections AAA Perforation
How do you assess back pain severity?
Keele Score
4+ is a physio referral
What is a yellow flag?
A warning sign that there may be something that could complicate the treatment and lead to chronic pain
Examples of yellow flags?
Medicolegal proceedings
Work issues
Hx or FHx of psychological problems
poor coping and support
What is a black flag?
Any environmental thing that could prevent improvement
e.g no time off work
How do you tell simple mechanical back pain?
Worse at the end of the day/with activity
Dull, aching pain
Age, occupation, male, weight
Improves with analgesia
How do you treat mechanical back pain?
Rest, reassure, lifestyle mods
Analgesia (NSAIDS)
Physiotherapy or exercise
What are the three general causes of BACK pain (not including visceral or other causes of pain that can be referred to the back)
1) Simple mechanical
2) Nerve Pain
3) Sinister pain - Red Flags
How does nerve pain present?
Shooting, sharp pain Can be sudden, upon bending etc Radiates down legs Disc herniation tends to be in younger patients Can have some neurological signs
What are the malignancies that are likely to cause back pain?
Metastasis
Multiple Myeloma
Prostate
What are some other bone problems?
Osteoporotic Fractures - wedge, compression
Rib Fractures - trauma
What is Cauda Equina Syndrome?
Symptoms
Compression of the bundle of nerves not protected by the vertebrae which leaves at L1/L2 level in adults
Normally occurs at L4 level
Back Pain Overflow incontinence Faecal Incontinence Saddle seat anesthesia Weakness, loss of reflexes Loss of anal tone Sexual dysfunction
Emergency decompression required otherwise can be come permanent
