backpain

Question 1

What is meant by sciatica

Answer 1

Pain arising in the back but predominantly radiates down the leg
(damage/compression of sciatic nerve)

Question 2

What is non-specific low back pain

Answer 2

Pain not due to any specific or underlying disease that can be found
No cancer, fracture, inflammation etc.

Question 3

What is the trouble with non-specific back pain

Answer 3

Must do many more investigations before finding causative condition
Many guidelines do not reach the stage of discovering cause

Question 4

What is mechanical low back pain

Answer 4

Pain after abnormal stress and strain on the vertebral column e.g. Whiplash

Question 5

What is nerve root pain

Answer 5

pain radiating to the lower limbs with or without neuralgic symptoms
(Sciatica)

Question 6

causes of back pain

Answer 6

Mechanical (90%)
Tumour including myeloma
Infection
Spondyloarthropathy
Pars interarticularis injury
Compression fracture
Visceral

Question 7

mechanical stress backpain can cause

Answer 7

Disc degeneration
Disc herniation
Annular tears
Facet joint OA
Instability

Question 8

indications of sciatica

Answer 8

pain spreads to feet/toes (referred pain stays above knee)
leg raise induces pain
unilateral leg pain more than back pain
numbness and paraesthesia in same distribution

Question 9

What is Spondyloarthropathy

Answer 9

Inflammatory joint disease
Falls under remit of rheumatologist
Treated aggressively with biologic agents with high rates of success

Question 10

What is Pars interarticularis injury

Answer 10

Bit between the facet joints
Can undergo stress fractures
Typical in those involved in dance (ballet), gymnastic or fast bowling
If they stop it heals nicely - but if left can cause serious problems

Question 11

What are compression fractures

Answer 11

Older age group with osteoporosis and ordinary activity can lead to a fracture e.g. washing up

Or major trauma

Question 12

NICE guidelines back pain imaging

Answer 12

not routinely offered
explain they nay not need imaging
consider it in specialist care

Question 13

possible treatments for back pain

Answer 13

Exercise
Manipulation
Psychological therapy
NSAIDs
Weak opioids
Radiofrequency denervation
Epidural

reasonable but not really helpful:
Injections
Acupuncture
Ultrasound therapy
Transcutaneous nerve stimulation
Paracetamol
Opioids
Spinal fusion
Disc replacement

Question 14

conservative management of back pain

Answer 14

analgesia
antiinflammatories
manipulation
accupuncture
massage
time
NOT BED REST

Question 15

red flags of low backpain

Answer 15

weight loss
fever
night pain
under 19

Question 16

red flags of leg pain

Answer 16

bowel bladder dysfunction
saddle anaesthesia
profound neuro deficit

Question 17

risks of waiting too long for red flags

Answer 17

metastases - risk of catastrophic fracture and paralysis
inflammatory arthropathy responds best to treatment early
myeloma - as above
tuberculosis of spine - as above

Question 18

primary imaging for back pain

Answer 18

MRI - soft tissues

so that you dont miss mets and myeloma

Question 19

methods for treating nerve pain

Answer 19

CT guided root block
MRI and US fusion
epidural anaesthetic
surgery - decompression, disc replacement, fusion

Question 20

surgical treatments for back pain

Answer 20

decompression of nerve roots of spinal stenosis
disc replacement
fusion

Question 21

what should be done for someone under 35 with three months of persistent backpain

Answer 21

spinal MRI to look for sponydloarthropathy