Back Pain

Question 1

With a prolapsed disc, the sciatic nerve is most commonly affected nerve. Sciatica means nerve root pain of the sciatic nerve.

Sciatica: Symptoms?

Answer 1

• Due to small disc prolapse
• Altered sensation in dermatomal pattern (big toe)
• Shooting pains down leg + may increase in intensity

Question 2

Sciatica: Treatment?

Answer 2

• Neuropathic drug → gabapentin / pregab / amitriptyline
• Physiotherapy
• 90% cases settle < 3m of conservative management
• Pain not settling after 4-6wks of physio and painkillers? → Spinal surgery

Question 3

All patients with nerve root compression should be given red-flag advice for cauda equina, including what?

Answer 3

• Peri-anal or saddle sensory change
• Difficulty passing urine
• Symptoms affecting both legs

Question 4

Lower limb nerve root compression sites and features

Answer 4

Question 5

Red flags for back pain?

Answer 5

• Trauma
• Unexplained weight loss
• Neurological symptoms
• Age > 50
• Fever
• IVDU
• Steroid use
• History of cancer (prostate, renal, breast, lung)