Back pain Flashcards
Tests to highlight the contribution of psychological and socioeconomic factors to spinal pain
Superficial tenderness Stimulation Distraction Regionalisation Overreaction
Superficial tenderness test
Tenderness is superficial or deeper tenderness is present in non-anatomical areas
Stimulation
Manoeuvres that should not be painful when performed eg passive rotation of shoulder/pelvis
Distraction
Do a test, then repeat when distracted.
eg +ve straight leg raise, then repeat when seated and examining the foot
Regionalisation
Findings that diverge from normal neuroanatomy
eg whole muscle groups affected that don’t share innervation
Overreaction
Inappropriate response to examination eg collapsing, excessive vocalisation
Management for mechanical back pain
Education - red flags
Avoid bed rest, stay mobilised and return to normal activities
Physiotherapy
Avoid precipitants
Pharmacology - NSAIDs, only opioids if short term/weak/not chronic
Sciatica features
Lower back pain, into buttocks and down one leg
Neuro signs in sciatic nerve distribution
Positive straight leg raise
Reduced range of movement due to pain
Sciatica causes
Prolapsed disc
Bony spurs
Spinal stenosis
Imaging for lower back pain
Do NOT do lumbar x ray
MRI if:
- non-specific back pain and would change management
- suspected: malignancy, infection, fracture, ankylosing spondylitis, cauda equina
Pharmacological management of back pain
NSAIDs first line
If sciatica, follow guidelines for neuropathic pain
Neuropathic pain management
1st line: amitriptyline, gabapentin, pregabalin, duloxetine
2nd line: one of the other above drugs
Tramadal can be used for rescue therapy
