Back Pain Flashcards
What percentage of the population are likely to be affected by back pain?
80%
What percentage of patients with back pain have sciatica?
5-10%
What percentage of the population suffer sciatica each year?
2%
What is meant by sciatica?
Pain arising in the back but predominantly radiates down the leg
What is non-specific low back pain?
Pain not due to anyspecificor underlying disease that can be found
No cancer, fracture, inflammation etc.
What is the trouble with non-specific back pain?
Must do many more investigations before finding causative condition
Many guidelines do not reach the stage of discovering cause
What is mechanical low back pain?
Painafter abnormal stress and strain on the vertebral column
e.g. Whiplash
What is nerve root pain?
Painradiating to the lower limbs with or without neuralgic symptoms
(Sciatica)
What are the causes of back pain?
Mechanical (90%) Tumour including myeloma Infection Spondyloarthropathy Pars interarticularis injury Compression fracture Visceral
What comprises mechanical stress?
Disc degeneration Disc herniation Annular tears Facet joint OA Instability
What are annular tears?
Little rips within the disc
Tears allow jelly to leak out to the outer margin of the discs
Chemicals of the jelly are irritant
In which tumour is there almost always back pain?
Myeloma
Often mistaken for mechanical back pain
Very important to diagnose early
What are the features of infection causing back pain?
Infection
More frequent if previous surgery
Increasingly common due to TB of the spine
What is Spondyloarthropathy?
Inflammatory joint disease
Falls under remit of rheumatologist
Treated aggressively with biologic agents with high rates of success
What is Pars interarticularis injury?
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
What are compression fractures?
Older age group with osteoporosis and ordinary activity can lead to a fracture e.g. washing up
Or major trauma
What is visceral back pain?
Pain that is coming from somewhere else in the body that makes you think you have back pain
e.g. aortic dissection, pancreatitis
What are indicators of sciatica?
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
What is the NICE guidance for imaging back pain?
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.
Why is imaging not that useful for back pain?
Not very helpful
Costs a lot of money
Takes a lot of time
What are the possible treatments for back pain?
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
Why do people often stop taking pain killers?
Pain killers often do not work very well but the side effects are bad
What is the conservative treatment for back pain?
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
What is the purpose of manipulation?
Move the muscles
Restore alignment
