Back Pain and Sciatica Flashcards
What is another term for low back pain?
Lumbago
How long does it take for acute back pain to improve?
1-2 weeks
4-6 weeks for sciatica
What are the causes of mechanical back pain?
Muscle or ligament sprain
Facet joint dysfuntion
Sacroiliac joint dysfunction
Herniated disc
Spondylolisthesis
Scoliosis
Degenerative changes
What is the difference between spondylosis and spondylolisthesis?
What causes neck pain?
Muscle or ligament strain
Torticollis
Whiplash
Cervical spondylosis
What are the red-flag causes of back pain?
Spinal fracture
Cauda equina
Spinal stenosis
Ankylosing spondylitis
Spinal infection
What abdominal or thoracic conditions can cause back pain?
Pneumonia
Ruptured aortic aneurysms
Kidney stones
Pyelonephritis
Pancreatitis
Prostatitis
Pelvic inflammatory disease
Endometriosis
What are the spinal nerve routes of the sciatic nerve?
L4-S3
Where does the sciatic nerve emerge?
Exits through the greater sciatic foramen inferior to the piriformis
What symptoms do you get from sciatica?
Unilateral pain radiating down the back of the thigh to below the knee
Shooting pain
Paraesthesia
Numbness
Motor weakness
What are the main causes of sciatica?
Herniated disc
Spondylolisthesis
Spinal stenosis
What is the sciatic stretch test?
Used to diagnose sciatica
Patient lies on their back, leg is lifted and ankle is dorsiflexed until limit is reached
How do you remember which cancers metastasise to the bones?
PoRTaBLe
(only consonants=cancer)
Prostate
Renal
Thyroid
Breast
Lung
What investigations are used for lower back pain?
Patients with mechanical/ non-specific lower back pain are diagnosed clinically, does not require further investigation
What is imaging used to look for with back pain?
X-rays or CT used to diagnose spinal fractures
MRI for suspected cauda equina
What investigations are used for ankylosing spondylitis?
Inflammatory markers (CRP and ESR- erythrocyte sedimentation rate)
X-ray of spine and sacrum
MRI of spine
What can X-ray and MRI show in ankylosing spondylitis?
X-ray
Bamboo spine
MRI
Bone marrow oedema early in disease
What is STarT Back Screening Tool used for?
Stratify risk of a patient presenting with acute back pain developing into chronic back pain
How is acute lower back pain managed?
Cauda equina-MRI
Ankylosing spondylitis-Inflammatory markers and rheumatology review
Spinal injury- Spinal immobilisation
How are patients with low risk of chronic back pain managed?
Education
Reassurance
Analgesia
Staying active
How are patients at medium or high risk of developing chronic back pain managed?
Physiotherapy
Cognitive behavioural therapy
Group exercise
What analgesia is used for lower back pain?
NSAIDs (ibuprofen or naproxen)
Codeine (alternative)
Benzodiazepines (e.g. diazepam) for muscle spasm (short term only 5 days)
Do not use opioids
What is radiofrequency denervation?
Targets and damages the medial branch nerves supplying the facet joints associated with back pain
When is radiofrequency denervation used?
Chronic lower back pain originating in the facet joints
What medications can be used for sciatica after following the acute back pain pathway?
Amitriptyline
Duloxetine
How does amitriptyline and duloxetine work?
Blocks NorAd and Serotonin uptake at synapses
Duloxetine also increases dopamine in the prefrontal cortex
What are the specialist management options of chronic sciatica?
Epidural corticosteroid injections
Local anaesthetic injections
Radiofrequency denervation
Spinal decompression
