back pain history

Question 1

associated symptoms

Answer 1

any other changes
cancer
incontinence or difficulty passing urine
bowel and bladder symptoms
numbness, tingling, leg weakness, peri-anal numbness

Question 2

red flags

Answer 2

onset age >55 or <20
nocturnal pain
history of carcinoma
progressive neurological deficit 
disturbed gait, saddle anaesthesia 
leg claudication
constant or progressive pain
morning stiffness
constitutional symptoms (fevers, weight loss, night sweats)
current or recent infection
bladder or bowel dysfunction
immunosupression

Question 3

causes of back pain 15-30

Answer 3

trauma
fracture
prolapsed disc
ankylosing spondylitis

Question 4

causes of back pain 30-50

Answer 4

degenerative disease
prolapsed disc
malignancy

Question 5

causes of back pain >50

Answer 5

degenerative disease
osteoporosis
malignancy
myeloma

Question 6

What cancers are most likely to metastasise to spine?

Answer 6

breast
lung
prostate
kidney 
thyroid

Question 7

management of back pain

Answer 7

examination
pain relief
lumbar X-ray or MRI scan
none scan / skeletal survey
specialist input

Question 8

Aetiology of mechanical back pain

Answer 8

low back pain arising from an anatomical structure such as a muscle, ligament, or IV disc due to trauma, deformity or degenerative change
Osteoporotic fracture

Question 9

Clinical presentation of mechanical back pain

Answer 9

sudden onset 
eased by rest
unilateral symptoms 
increased by coughing / sneezing 
previous episodes, clear mechanical precipitant

Question 10

Aetiology of inflammatory back pain

Answer 10

inflammatory spoldylitis
infection (epidural abscess)
malignancy
paget’s disease

Question 11

Clinical presentation of inflammatory back pain

Answer 11

predominant stiffness (greater than 30 mins in morning)
gradual onset and progressive
increased pain with rest
disturbs sleep
stiff / rigid spine on examination, symmetrical restriction +/- sacroiliac joint tenderness

Question 12

Describe cauda equina syndrome

Answer 12

compression of cauda equina
prolapsed disc herniation
metastases
persistant and progressive, bilateral leg pain, normal leg pulses, pain eased on sitting forward, stiff spine on examination, bladder / bowel dysfunction

Question 13

Describe sciatica

Answer 13

pain radiates from buttock down back of the leg and into the foot
paraesthesia in ipsilateral side
compression of lumbo-sacral nerve root by protruding disc
usually managed with analgesia and physiotherapy
surgery sometimes

Question 14

investigations for non-mechanical back pain

Answer 14

CRP / ESR
RBC
calcium and phosphate 
ALP
protein electrophoresis
blood cultures if appropriate
imaging 
rheumatoid factor
anti-CCP antibodies