Back Pain Presentations

Question 1

What are the main causes of back pain in 15-30 year olds?

Answer 1

Prolapsed disc, trauma, fractures, ankylosing spondylitis, spondylolisthesis, pregnancy.

Question 2

What are the main causes of back pain in >30 year olds?

Answer 2

Prolapsed disc, malignancy (breast, lung, thyroid, prostate, kidney).

Question 3

What are the main causes of back pain in >50 year olds?

Answer 3

Degenerative, osteoporosis, Paget’s malignancy, myeloma.

Question 4

Back pain yellow/red flag:

Belief pain is harmful

Answer 4

Yellow

Question 5

Back pain yellow/red flag:

Pain behaviour

Answer 5

Yellow

Question 6

Back pain yellow/red flag:

Reliance on pain relief

Answer 6

Yellow

Question 7

Back pain yellow/red flag:

Depression/anxiety

Answer 7

Yellow

Question 8

Back pain yellow/red flag:

Unsupportive home environment

Answer 8

Yellow

Question 9

Back pain yellow/red flag:

Inappropriate expectations

Answer 9

Yellow

Question 10

How are back pain yellow flags managed?

Answer 10

1. Disabling pain >2 weeks - refer to physio

2. Disabling pain >6 weeks despite physio and analgesia - 2 week referral

Question 11

Back pain yellow/red flag:

Age <20 or >55

Answer 11

Red

Question 12

Back pain yellow/red flag:

Constant/progressive pain

Answer 12

Red

Question 13

Back pain yellow/red flag:

Nocturnal pain

Answer 13

Red

Question 14

Back pain yellow/red flag:

Fever, night sweats, weight loss

Answer 14

Red

Question 15

Back pain yellow/red flag:

History of malignancy

Answer 15

Red

Question 16

Back pain yellow/red flag:

Abdominal mass

Answer 16

Red

Question 17

Back pain yellow/red flag:

Thoracic back pain

Answer 17

Red

Question 18

Back pain yellow/red flag:

Morning stiffness

Answer 18

Red

Question 19

Back pain yellow/red flag:

Neurological disturbance

Answer 19

Red (sciatica)

Question 20

Back pain yellow/red flag:

Bowel/urinary disturbance

Answer 20

Red

Question 21

Back pain yellow/red flag:

Saddle anaesthesia

Answer 21

Red

Question 22

Back pain yellow/red flag:

Immunosuppression (steroids/HIV)

Answer 22

Red

Question 23

Back pain yellow/red flag:

Leg claudication

Answer 23

Red

Question 24

How are back pain red flags managed?

Answer 24

Immediate referral

Question 25

What investigations should be considered in back pain?

Answer 25

1. FBC, ESR, CRP, U&Es
2. ALP (raise in Paget’s)
3. Serum/urine electrophoresis (myeloma)
4. PSA (prostate)
5. X-ray (fractures)
6. MRI (disc prolapse/stenosis/infection)

Question 26

What are the red flag symptoms for cauda equina (immediate MRI)

Answer 26

1. Bilateral lower limb neurology
2. Sphincter dysfunction
3. Painless urinary retention
4. Reduced perianal sensation