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Z Year 2 BRS MSK > Back Pain > Flashcards

Back Pain Flashcards

1
Q

How many people suffer from lower back pain?

A

-49% to 70% of people will suffer low back pain

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2
Q

How long does it usually take for back pain to get better?

A

-Most are better in a few days 96% are better in six weeks

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3
Q

How many patient with low back pain have sciatica?

A

5% to 10%

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4
Q

What percentage of the population suffer sciatica in one year?

A

2%

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5
Q

What percentage of people recover from sciatica?

A
  • 60% recover from sciatica in three months
  • 70% recover from sciatica in 12 months
  • 30% continue to have sciatica for over one yea
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6
Q

What is non-specific low back pain?

A

Pain not due to anyspecificor underlying disease that can be found

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7
Q

What is mechanical low back pain?

A

Painafter abnormal stress and strain on the vertebral column

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8
Q

What is nerve root pain (sciatica)?

A

Painradiating to the lower limbs with or without neuralgic symptoms

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9
Q

What are mechanical causes of lower back pain (90%)?

A
  1. Disc degeneration
  2. Disc herniation
  3. Annular tears
  4. Facet joint OA
  5. Instability
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10
Q

Which causes of lower back pain have specific treatment?

A
  • Tumour including myeloma
  • Infection
  • Spondyloarthropathy
  • Pars interarticularis injury
  • Compression fracture
  • Visceral
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11
Q

What are indicators for sciatica in the history and physical examination?

A
  1. Unilateral leg pain greater than low back pain
  2. Pain radiating to foot or toes
  3. Numbness and paraesthesia in the same distribution
  4. Straight leg raising test induces more leg pain
  5. Localised neurology—that islimited to one nerve root
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12
Q

What is the nice guidance for imaging with lower back pain?

A
  1. Do not routinely offer imaging in a non-specialist setting for people with low back pain with or without sciatica.
  2. 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.
  3. 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.
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13
Q

What are not show evidence treatments for lower back pain?

A
  1. Injections
  2. Corsets
  3. Traction
  4. Acupuncture
  5. Ultrasound therapy
  6. Transcutaneous nerve stimulation
  7. Paracetamol
  8. Opioids
  9. Spinal fusion
  10. Disc replacement
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14
Q

What are shown evidence treatments for lower back pain?

A
  1. Exercise
  2. Manipulation
  3. Psychological therapy
  4. NSAIDs
  5. weak opioids
  6. radio-frequency denervation
  7. epidural
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15
Q

What is some conservative treatment for lower back pain?

A
  1. Analgesia (Paracetamol)
  2. Anti-inflammatory drugs
  3. Manipulation
  4. Acupuncture
  5. Massage
  6. Allow some time to pass
  7. Bed rest does not result in faster recovery
  8. Most patients get better spontaneously
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16
Q

What is some red flags for low back pain?

A
  1. Weight loss
  2. Fever
  3. Night pain
  4. Under 19 years
17
Q

What is some red flags for leg pain?

A
  1. Bowel or bladder dysfunction
  2. Saddle anaesthesia
  3. Profound neurological deficit
18
Q

What happens if you wait too long with metastases?

A
  1. Early diagnosis may not impact on prognosis
  2. Risk of catastrophic fracture and paralysis
  3. Onset of symptoms to referral median 3 months
19
Q

What happens if you wait too long with inflammatory arthropathy?

A
  1. Early diagnosis for effective treatment with biologics

2. Investigate under 35 years after 3 months pain

20
Q

What happens if you wait too long with myeloma?

A
  1. Early diagnosis will catch disease at a more easily treated stage
  2. Mean delay in diagnosis - interquartile range 84 to 306 days
21
Q

What happens if you wait too long with TB of spine?

A
  1. Early diagnosis is essential to effective treatment

2. Mean delay in diagnosis - 4 to 11 months

22
Q

What is the primary imaging for low back pain?

A

MRI

23
Q

What are secondary investigations for low back pain?

A

Radiographs, CT

24
Q

What is good about radiographs?

A
  • Cheap
  • Readily available
  • Traditional
25
Q

What is bad about radiographs?

A
  • Radiation

- Overlook most important -diseases

26
Q

Why is diagnostic imaging important?

A
  • Radiographs have negligible value in the assessment of back pain
  • CT is an adjunct in a few cases
  • MRI is the workhorse
  • Low back pain is non-specific until you investigate
27
Q

What are the options for pain therapy?

A
  1. Wait – how long
  2. Physical therapy
  3. Analgesia
  4. Facet injections
  5. local & steroid
  6. denervation
  7. Root block
  8. Epidural injection
  9. Neurostimulation
28
Q

What approaches are there for facet injections?

A
  1. oblique

2. posterior : inject in posterior inferior extension of joint

29
Q

What is involved in a facet injection?

A
  • 21g needle
  • Local - Marcain 0.5% 1ml
  • Steroid - Triamcinolone 20mg
  • One level at a time
  • Follow up
  • Inside or around the joint
30
Q

How do you do a root block?

A
  • contrast in root sheath
  • one ml.local only
  • follow up
31
Q

What is a new imaging method?

A

fusion imaging

32
Q

What are different types of epidural anaesthetic?

A
  • Interlaminar
  • Transforaminal
  • Caudal
33
Q

What does surgery for back pain involve?

A
  • Decompression of nerve roots
  • Decompression of spinal stenosis
  • Disc replacement
  • Fusion

Z Year 2 BRS MSK (18 decks)

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