Backpain

Question 1

How does mechanical back pain present?

Answer 1

• Typically, worse when moving
• Develop suddenly or gradually
• Results of poor posture or lifting something awkwardly at times
• Minor injury such as Sprain or strain
• Associated with stress sometimes

Question 2

How is mechanical back pain managed?

Answer 2

• Get better over time few weeks
• Assess risk with StarT Back for lower back pain
• Self-management advice
• Offer analgesia to manage the pain

Question 3

Which analgesia are used to manage mechanical back pain?

Answer 3

• NSAIDs to start. If contraindication, then codeine with or without paracetamol
• Codeine with/without paracetamol. 30-60 mg every 4 hours
• If presenting with back spasms, then short course of benzodiazepine such as diazepam (2mg up to 3 times a day for up to 5 days)
• Follow up if the symptoms persist or worsen after 3-4 weeks

Question 4

How does cauda equina present?

Answer 4

• Bilateral sciatica
• Severe or progressive bilateral neurological deficit of the legs such as motor weakness with knee extension, ankle eversion or foot dorsiflexion
• Difficulty initiating micturition or impaired sensation of urinary glow, if untreated this may lead to irreversible. (Overflow Incontnence)
• Loss of sensation of rectal fullness leading to faecal incontinence
• Perianal, perineal or genital sensory loss (saddle anaesthesia)
• Laxicity of the anal sphincter

Question 5

HOw is cauda equina managed?

Answer 5

-Refer for imaging and specialist assessment as soon as possible as it is an emergency

Question 6

How does a slipped disc present?

Answer 6

• Lower back pain
• Numbness or tingling in your shoulder, back, arms, hands, legs, or feet
• Neck pain
• Problems bending or straightening your back
• Muscle weakness
• Pain in the buttocks, hips or legs if the disc is pressing on the sciatic nerve

Question 7

How is a slipped disc managed?

Answer 7

• Keep active
• Take analgesics such as ibuprofen and paracetamol. Take regularly. Codeine can be taken if NSAIDS contraindicated. Codeine with/without paracetamol. 30-60 mg every 4 hours
• Physiotherapist
• GP can treat with steroid injection, muscle relaxant or stronger painkiller

Question 8

How does sciatica present?

Answer 8

• Inability to straight leg raise
• Painful/Tingling/Numbness/Weakness in the bottom, back of your legs or feet and toes
• May have back pain as well

Question 9

How is sciatica managed?

Answer 9

• Prescription of painkillers (NSAIDs at the lowest dose with gastroprotection, Codeine with/without paracetamol. 30-60 mg every 4 hours)
• Suggest exercises and stretches
• Physiotherapist
• Psychological support
• If spasms consider prescription of diazepam

Question 10

How does ankylosing spondylitis present?

Answer 10

• Back pain and stiffness, mostly around the sacral area
• Pain and swelling in other parts of the body caused by inflammation of the joints and inflammation where a tendon joins a bone
• Extreme tiredness

Question 11

How is ankylosing spondylitis managed?

Answer 11

• Exercises carried out individually or in groups to reduce pain and stiffness
• Physiotherapist where physical methods such as massage and manipulation are used to improve comfort and spinal flexibility
• Medication to help relieve pain and reduce inflammation such as pain killers such as NSAIDs, anti TNF medication and biological therapies