Back Pain Flashcards
How many people suffer from lower back pain?
-49% to 70% of people will suffer low back pain
How long does it usually take for back pain to get better?
-Most are better in a few days 96% are better in six weeks
How many patient with low back pain have sciatica?
5% to 10%
What percentage of the population suffer sciatica in one year?
2%
What percentage of people recover from sciatica?
- 60% recover from sciatica in three months
- 70% recover from sciatica in 12 months
- 30% continue to have sciatica for over one yea
What is non-specific low back pain?
Pain not due to anyspecificor underlying disease that can be found
What is mechanical low back pain?
Painafter abnormal stress and strain on the vertebral column
What is nerve root pain (sciatica)?
Painradiating to the lower limbs with or without neuralgic symptoms
What are mechanical causes of lower back pain (90%)?
- Disc degeneration
- Disc herniation
- Annular tears
- Facet joint OA
- Instability
Which causes of lower back pain have specific treatment?
- Tumour including myeloma
- Infection
- Spondyloarthropathy
- Pars interarticularis injury
- Compression fracture
- Visceral
What are indicators for sciatica in the history and physical examination?
- 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 islimited to one nerve root
What is the nice guidance for imaging with lower 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.
What are not show evidence treatments for lower back pain?
- Injections
- Corsets
- Traction
- Acupuncture
- Ultrasound therapy
- Transcutaneous nerve stimulation
- Paracetamol
- Opioids
- Spinal fusion
- Disc replacement
What are shown evidence treatments for lower back pain?
- Exercise
- Manipulation
- Psychological therapy
- NSAIDs
- weak opioids
- radio-frequency denervation
- epidural
What is some conservative treatment for lower 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 some red flags for low back pain?
- Weight loss
- Fever
- Night pain
- Under 19 years
What is some red flags for leg pain?
- Bowel or bladder dysfunction
- Saddle anaesthesia
- Profound neurological deficit
What happens if you wait too long with metastases?
- Early diagnosis may not impact on prognosis
- Risk of catastrophic fracture and paralysis
- Onset of symptoms to referral median 3 months
What happens if you wait too long with inflammatory arthropathy?
- Early diagnosis for effective treatment with biologics
2. Investigate under 35 years after 3 months pain
What happens if you wait too long with myeloma?
- Early diagnosis will catch disease at a more easily treated stage
- Mean delay in diagnosis - interquartile range 84 to 306 days
What happens if you wait too long with TB of spine?
- Early diagnosis is essential to effective treatment
2. Mean delay in diagnosis - 4 to 11 months
What is the primary imaging for low back pain?
MRI
What are secondary investigations for low back pain?
Radiographs, CT
What is good about radiographs?
- Cheap
- Readily available
- Traditional
What is bad about radiographs?
- Radiation
- Overlook most important -diseases
Why is diagnostic imaging important?
- 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
What are the options for pain therapy?
- Wait – how long
- Physical therapy
- Analgesia
- Facet injections
- local & steroid
- denervation
- Root block
- Epidural injection
- Neurostimulation
What approaches are there for facet injections?
- oblique
2. posterior : inject in posterior inferior extension of joint
What is involved in a facet injection?
- 21g needle
- Local - Marcain 0.5% 1ml
- Steroid - Triamcinolone 20mg
- One level at a time
- Follow up
- Inside or around the joint
How do you do a root block?
- contrast in root sheath
- one ml.local only
- follow up
What is a new imaging method?
fusion imaging
What are different types of epidural anaesthetic?
- Interlaminar
- Transforaminal
- Caudal
What does surgery for back pain involve?
- Decompression of nerve roots
- Decompression of spinal stenosis
- Disc replacement
- Fusion
