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Year 2 MSK > Back Pain > Flashcards

Back Pain Flashcards

1
Q

What percentage of the population are likely to be affected by back pain?

A

80%

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2
Q

What percentage of patients with back pain have sciatica?

A

5-10%

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3
Q

What percentage of the population suffer sciatica each year?

A

2%

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4
Q

What is meant by sciatica?

A

Pain arising in the back but predominantly radiates down the leg

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5
Q

What is non-specific low back pain?

A

Pain not due to anyspecificor underlying disease that can be found

No cancer, fracture, inflammation etc.

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6
Q

What is the trouble with non-specific back pain?

A

Must do many more investigations before finding causative condition

Many guidelines do not reach the stage of discovering cause

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7
Q

What is mechanical low back pain?

A

Painafter abnormal stress and strain on the vertebral column

e.g. Whiplash

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8
Q

What is nerve root pain?

A

Painradiating to the lower limbs with or without neuralgic symptoms
(Sciatica)

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9
Q

What are the causes of back pain?

A 
Mechanical (90%)
Tumour including myeloma
Infection
Spondyloarthropathy
Pars interarticularis injury
Compression fracture
Visceral
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10
Q

What comprises mechanical stress?

A 
Disc degeneration
Disc herniation
Annular tears
Facet joint OA
Instability
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11
Q

What are annular tears?

A

Little rips within the disc

Tears allow jelly to leak out to the outer margin of the discs

Chemicals of the jelly are irritant

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12
Q

In which tumour is there almost always back pain?

A

Myeloma
Often mistaken for mechanical back pain
Very important to diagnose early

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13
Q

What are the features of infection causing back pain?

A

Infection
More frequent if previous surgery
Increasingly common due to TB of the spine

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14
Q

What is Spondyloarthropathy?

A

Inflammatory joint disease
Falls under remit of rheumatologist
Treated aggressively with biologic agents with high rates of success

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15
Q

What is Pars interarticularis injury?

A

Bit between the facet joints

Can undergo stress fractures

Typical in those involved in dance (ballet), gymnastic or fast bowling

If they stop it heals nicely - but if left can cause serious problems

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16
Q

What are compression fractures?

A

Older age group with osteoporosis and ordinary activity can lead to a fracture e.g. washing up

Or major trauma

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17
Q

What is visceral back pain?

A

Pain that is coming from somewhere else in the body that makes you think you have back pain

e.g. aortic dissection, pancreatitis

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18
Q

What are indicators of sciatica?

A

Unilateral leg pain greater than low back pain

Pain radiating to foot or toes

Numbness and paraesthesia in the same distribution

Straight leg raising test induces more leg pain

Localised neurology—that is, limited to one nerve root

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19
Q

What is the NICE guidance for imaging back pain?

A

Do not routinely offer imaging in a non-specialist setting for people with low back pain with or without sciatica.

Explain to people with low back pain with or without sciatica that if they are being referred for specialist opinion, they may not need imaging.

Consider imaging in specialist settings of care (for example, a musculoskeletal interface clinic or hospital) for people with low back pain with or without sciatica only if the result is likely to change management.

20
Q

Why is imaging not that useful for back pain?

A

Not very helpful
Costs a lot of money
Takes a lot of time

21
Q

What are the possible treatments for back pain?

A 
Injections
Exercise
Corsets
Traction
Manipulation
Acupuncture
Ultrasound therapy
Transcutaneous nerve stimulation
Psychological therapy
NSAIDS
Paracetamol
Weak opioids
Opioids
Radiofrequency denervation
Epidural
Spinal fusion
Disc replacement
22
Q

Why do people often stop taking pain killers?

A

Pain killers often do not work very well but the side effects are bad

23
Q

What is the conservative treatment for back pain?

A 
Analgesia (Paracetamol)
Anti-inflammatory drugs
Manipulation
Acupuncture
Massage
Allow some time to pass

Bed rest does not result in faster recovery

Most patients get better spontaneously

24
Q

What is the purpose of manipulation?

A

Move the muscles

Restore alignment

25
Q

Why can acupuncture be considered?

A

Worth a try

Rarely does any harm

26
Q

What is the aim of conservative treatment?

A

Most pain will resolve itself

These will help the patient feel more comfortable during the healing period

27
Q

What are the red flag signs for lower back pain?

A

Weight loss
Fever
Night pain
Under 19 years

28
Q

What is weight loss a sign of?

A

Cancer or Infection

29
Q

What is needed when back pain if found in under 19s?

A

Urgent MRI

30
Q

What are the red flags symptoms for sciatica?

A

Bowel or bladder dysfunction
Saddle anaesthesia
Profound neurological deficit

31
Q

What are the features of spinal metastases?

A

Early diagnosis may not impact on prognosis
Risk of catastrophic fracture and paralysis
Onset of symptoms to referral median 3 months

32
Q

What are the features of myeloma?

A

Early diagnosis will catch disease at a more easily treated stage
Mean delay in diagnosis - interquartile range 84 to 306 days

33
Q

What are the features of spinal TB?

A

Early diagnosis is essential to effective treatment

Mean delay in diagnosis - 4 to 11 months

34
Q

What are the features of Inflammatory arthropathy?

A

Early diagnosis for effective treatment with biologics

Investigate under 35 years after 3 months pain

35
Q

What is the primary investigation for lower back pain?

A

MRI

36
Q

What are secondary investigations for lower back pain?

A

Radiographs

CT

37
Q

What are the features of radiographs?

A

Cheap
Readily available
Traditional

Moderate Radiation
Overlook most important diseases

38
Q

Why might young people get osteoporosis?

A

Anorexia nervosa

39
Q

What is important to note about scans?

A

They can miss lesions

Must use multiple imaging if unsure

40
Q

What is osteoid osteoma?

A

Benign tiny tumour of bone that causes a massive reaction - oedema

41
Q

How is osteoid osteoma cured?

A

Day case simple ablation procedure

42
Q

Summarise the effectiveness of imaging for low back pain?

A

Radiographs have negligible value in the assessment of back pain

CT is an adjunct in a few cases

MRI is the workhorse

43
Q

What is important to always remember with low back pain?

A

Low back pain is non-specific until you investigate

Cannot just dismiss as mechanical if persistent

44
Q

In primary practice what is important to do with regards to low back pain?

A

Keep patient reasonably active within the bounds of pain

Not extended periods of back pain

45
Q

What are the methods for treating nerve pain?

A

Root block

CT guided root block

Year 2 MSK (9 decks)

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