Back Pain ****

Question 1

Examination:

SPINE EXAM IS DONE AND SHOULD GUIDE YOU TOWARDS AETIOLOGY

Answer 1

Examination:

SPINE EXAM IS DONE AND SHOULD GUIDE YOU TOWARDS AETIOLOGY

Question 2

Red flags:

Under what age should you be worried?

Over what age should you be worried?

What does leg claudication suggest?

What does bowel and bladder symptoms suggest?

What does numbness in the saddle area suggest?

What co-morbidities would you be worried about?

What does progressive or constant pain suggest?

Answer 2

<20

> 55

Spinal stenosis

Cauda equina

Cauda equina

HIV
Cancer
Steroid use

Cancer

Question 3

Mneumonic for red flags:

CT BACK PAIN:

What does it stand for?

Answer 3

Constitutional symptoms - infection of cancer 
Thoracic pain
Bowel/bladder symptoms
Anaesthesia of saddle area
Co-morbidities
Klaudication
Progressive or constant pain 
Age 
Insomnia 
Neurological symptoms

Question 4

Differentials - Mechanical:

Mechanical back pain and trauma!

What can cause nerve root compression?

Answer 4

Disc herniation - the herniation itself can cause pain without nerve root compression tbh

Question 5

Differentials - Bone disease:

What affects the spine?

What bone disease would cause veterbral crush fractures?

This disease interferes with your body’s normal recycling process, in which new bone tissue gradually replaces old bone tissue. Over time, the disease can cause affected bones to become fragile and misshapen. What is this disease called?

Answer 5

AS

Osteoporosis

Paget’s Disease

Question 6

Differentials - Neurological:

Cauda equina syndrome - what 3 symptoms do they have?

What does spinal stenosis cause in the feet?

Nerve root compression - Where does the pain radiate to?

Answer 6

Bilateral leg weakness
Incontinence
Saddle anaesthesia

Claudication

Unilateral leg neuro symptoms,
Pain radiates to the foot

Question 7

What investigation is needed if it is urgent?

Answer 7

Spinal MRI

Question 8

Mechanical back pain:

What is this?

S+S:

• Where do they get pain?
• What causes the pain to change?
• How long does it take for the symptoms to resolve?

Answer 8

Back pain in the absence of obvious pathologies such as OA or disc prolapse

Lumbosacral area, buttocks, and/or thighs

Question 9

Mechanical back pain:

Psychological yellow flags for chronic back pain:
- JUST READ

• What advice should you give the patient?
• READ PAGE 542 AT BOTTOM FOR GENERAL MANAGEMENT

Answer 9

Believe in pain and activity harmful 
Low mood 
Sickness behaviour 
Work dissatisfaction 
Is seeking compensation 
Not engaged in treatment 

Educate about back pain and encourage to stay active and avoid bed rest