Back pain MDT

Question 1

Name some red flags for cauda equina syndrome

Answer 1

Bilateral sciatica, 
Severe neurological deficit of legs,
Urinary incontinence/retention, faecal incontenance, loss of fullness
Saddle anaesthesia/paraesthesia,
Laxity of anal sphincter

Question 2

Name some red flags for spinal fractures

Answer 2

Sudden onset of severe central spinal pain, relieved by lying down
History of major trauma,
Osteoporosis/corticosteroids
Structural deformity of spone
Point of tenderness on vertebral body

Question 3

Name some red flags for malignancy (back)

Answer 3

Over 50

Gradual onset

Night pain

Localised spinal tenderness

No symptomatic improvement after 4-6 weeks of conservative low back pain therapy

Unexplained weight loss

Past history of cancer

Question 4

Name some red flags for infection (back)

Answer 4

Fever

TB or UTIs

Diabetes

History of IV drug use

HIV infection, immunosuppresssants/ immunocompromised

Question 5

What are yellow flags

Answer 5

Yellow flags are psychosocial factors that increase the risk of developing or perpetuating long-term disability and work loss associated with low back pain.

Question 6

What is bilateral sciatica a red flag for

Answer 6

Cauda equina syndrome

Question 7

What is Urinary incontinence/retention a red flag for

Answer 7

Cauda equina syndrome

Question 8

What is faecal incontinence/loss of sensation of rectal fullness a red flag for

Answer 8

Cauda equina syndrome

Question 9

What is saddle anaesthesia a red flag for

Answer 9

Cauda equia syndrome

Question 10

What is sudden onset of severe spinal pain a red flag for

Answer 10

spinal fracture

Question 11

What is a history of trauma a red flag for

Answer 11

spinal fracture

Question 12

What is osteoporosis/corticosteroid use a red flag for?

Answer 12

spinal fracture

Question 13

What is structural deformity of the spine a red flag for?

Answer 13

spinal fracture

Question 14

What is being aged o50 or over a potential red flag for

Answer 14

malignancy

Question 15

What is gradual onset a red flag for

Answer 15

malignancy

Question 16

What is night pain a red flag for

Answer 16

malignancy

Question 17

What is localised spinal tenderness a red flag for

Answer 17

malignancy

Question 18

What is unexplained weight loss a red flag for

Answer 18

malignancy

Question 19

What is a past history of cancer a red flag for

Answer 19

malignancy

Question 20

What is fever a red flag for

Answer 20

Infection

Question 21

What is a history of TB or a recent UTI a red flag for?

Answer 21

Infection

Question 22

What is daibetes a red flag for

Answer 22

Infection

Question 23

What is IV drug use a red flag for

Answer 23

Infection

Question 24

What is HIV/Immunosupression a red flag for?

Answer 24

Infection

Question 25

What are the yellow flags associated with back pain?

Answer 25

Attitudes, beliefs, compensation, diagnosis, emotions, family, work

Question 26

Which professions make up pain management?

Answer 26

Medical staff, nursing staff, physio staff, psychology staff, occupational therapy staff

Question 27

What do physiotherapists do

Answer 27

Physiotherapists apply knowledge, skills and judgement to promote health and also to assess and breakdown the barriers that restrict physical function.

Question 28

What is the boom and bust cycle?

Answer 28

Person has a good day, needs to catch up, leads to them overdoing it, increasing pain. Rests to recover, cycle restarts.

Decreasing overall level of activity

Question 29

How does graded exercise therapy work

Answer 29

Patient proceeds gradually to get challenged without straining themselves

Question 30

What is biopsychosocial assessment?

Answer 30

Takes into account biological, psychological, and social factors with regard to health

Question 31

What counts as biological assessment

Answer 31

Red flags, history, past illnesses, and medication regime

Question 32

Describe the cognnitive aspects of the biopsychosocial model

Answer 32

Attitudes, beliefs, compensation, diagnosis

Question 33

Describe the impact of emotion on healthcare

Answer 33

Emotional difficulties like depresssion/anxious states are at higher risk of long term health issues. Previous psychiatric history/current issues

Question 34

Describe the behavioural impact on healthcare

Answer 34

Changes in social/occupational / physical/sleep activities

Question 35

WHat is the focus of pain mamnagement

Answer 35

People are not helpless, can take an active approach in helping their pain

Question 36

What is cognitive behavioural therapy?

Answer 36

relationship between thoughts, feelings, physical state and behaviour , with a focus on identifying and modifying less helpful patterns and developing more adaptive coping skills.

Question 37

Desctibe the fear avoidance model of chronic pain

Answer 37

Ijury leads to pain epxerience, leading to catastrophising, leading to fear, to avoidance, and then to disuse, depression, disability. Feeds back into pain experience as a cycle

However, the cycle can be broken as from pain expereince is another channel: No fear, leading to confrontation, and recovery

Question 38

What does ACT therapy stand for

Answer 38

Acceptance and commitment therapy

Question 39

How does ACT therapy work

Answer 39

Instead of withdrawing and ignoring the issue, ACT is not about reducing pain but proposes awareness and changing relationship with internal experiences.

Enabling someone to do things that matter to them in the presence of adverse experiences