Back pain Flashcards
What is the prognosis of acute low back pain?
90% of patients recover without sequelae.
What is chronic LBP?
Chronic LBP is defined as symptoms persistent for >6 months.
How is lower back pain subdivided?
Time frame
How long does acute lower back pain last?
Less than 4 weeks
How long does subacute lower back pain last?
Lasting 4 to 12 weeks
How long does chronic lower back pain last?
Greater than 12 weeks
What are the risk factors for developing disabling LBP?
Maladaptive pain coping behaviours. Non-organic signs. Functional impairment. Poor general health status. Psychiatric comorbidities.
Differential diagnoses for back pain
Mechanical back pain Fractures Malignancy Infection Inflammatory/autoimmune Other causes- Pneumonia, Ureteric colic/Pyelonephritis, Peptic ulcer disease, Pancreatitis and Abdominal Aortic Aneurysm, Ovarian cysts, Endometriosis, Herpes zoster, Psychological causes.
What is mechanical back pain?
Most common causes of back pain.
Mechanical back pain is usually aggravated by movements, and certain postures.
How do you diagnose mechanical back pain?
Diagnosis is made by eliminating specific lower back pain causes of neurological compromise, neoplasia, inflammatory arthritis, fracture, or referred pain from other locations or organ systems.
What conditions classifies as mechanical back pain?
These conditions include: Lumbar muscle sprain/strain Bulging, Herniated or Degenerative Intervertebral Disc Spinal stenosis Facet joint disease (osteoarthritis)
Which questions should you ask in the hx of a px presenting with back pain?
Establishing when the pain started.
Confirming whether pain was sudden or gradual in onset.
Identifying the location of the pain.
Enquiring whether there is pain radiation to anywhere else.
Establishing whether there are aggravating or relieving factors.
Confirming whether the patient has had this problem previously.
Noting the patient’s occupation, what it involves and hobbies or sport.
Asking the patient to confirm what they think caused the pain.
Noting past medical history. Steroid use predisposes to osteoporosis. Establish whether there has been malignancy that metastasises to bone (lung, breast, prostate, thyroid, kidney) or myeloma.
Asking the patient to confirm how they have been managing the condition. This includes analgesics taken, whether they have been adequate and the patient’s attitude to the condition.
How can you assess the contribution of psychological and socioeconomic factors to spinal pain?
Waddell described signs that are useful in evaluating patients with lower back pain and are useful in high-lighting the contribution of psychological and socioeconomic factors to spinal pain.
Superficial tenderness: light touch over a wide lumbar area or deeper tenderness in non-anatomical areas.
Stimulation: manoeuvres that should not be painful when perfomed, such as axial loading of the head or passively rotating the shoulders or pelvis..
Distraction: performing a provocative test in the usual manner and rechecking when the patient is distracted. Eg performing a straight leg raise test, then asking re-examining with the patient in the seated positioning while examining the foot.
Regionalisation: presence of findings that diverge from accepted neuroanatomy. Such as entire muscles groups which do not have common innervation.
Overreaction: disproportionate response to examination such as collapsing, inappropriate facial expressions, excessive verbalisation.
