Back Pain Presentations☺️

Question 1

Epidemiology

Etiology, risk factors

Answer 1

Prevalence peaks at 40s

Risk factors

• obesity
• occupational heavy lifting
• depression, psych

Question 2

Possible differentials

-how may they present

Answer 2

Cauda equina => bowel, bladder retention, overflow, bilateral keg weakness, butt numbness, anal sphincter laxity

Spine cancer => tumour presses on SC, leading to numbness and weakness, difficulty walking, paralysis, incontinence/retention, night pain, cancer signs

Spinal fracture => trauma, osteoporosis, cancer

Osteomyelitis => IC, IVDU, elderly, signs of infection, pain and swelling around site

AS => pain that is not relieved supine, morning stiffness, gradual onset
-REFER TO RHEUMATOLOGY

Shingles => vesicular rash along unilateral dermatome

Sciatica (compression => unilateral shooting pain/tingling/numb/weakness past knee, +ve Babinski, +ve straight leg raising test

Question 3

Possible intra abdominal causes

Answer 3

GI
-pancreatitis => alcohol, gallstone history, epiblast rich pain with back radiation, vomiting, fever

GU
-pyelonephritis => flank pain, fever, UTI symptoms

Question 4

Management for the most common diagnosis

• conservative
• follow up

Answer 4

Non specific low back pain
-STarT Back risk stratification => assess modifiable risk factors

Conservative

• physical activity
• heat packs for pain and spasm
• NSAIDs

Follow up for red flags

If nerve related cause found

• facet joint injection - targetted analgesia
• radiofrequency denervation

Question 5

Prognosis

Answer 5

Generally self limiting but may recur

-may become chronic, accompanied by depression, days off work

Question 6

Red flags

Answer 6

Previous cancer
Major trauma
U20, 50+
Weight loss
Night pain
Leg weakness
Bladder/bowel incontinence
Sensory level

Question 7

Investigations

Answer 7

MSK exam
-Gait, posture, swelling, rash, deformity of back

Neuro exam

• changes in sensation, reflexes, limitation of mv
• straight leg test - sciatica
• test anal tone if suspecting cauda equina

Do not request Xray unless suspecting fracture

Question 8

Diagnosis of non specific lower back pain

Answer 8

Pain varies with posture and time, exacerbated by movement.

Pain is diffuse, non focal