Backpain Flashcards
How can you relive back pain?
- Stay active
- Try exercises and stretches
- Rake anti inflammatory ibuprofen
- Use hot or cold compression packs
What sort of support can you get for back. pain?
1, group exercises
- Manual therapy treatments
- psychological support
What medical conditions can cause back pain?
- prolapsed disc
- sciatica
- ankylosing spondylitis
- spondylolisthesis
How can you prevent back pain?
- Regular exercises and stretches
- Stay active
- Avoid sitting for long periods of time
- Take care when lifting
- Check posture when sitting
- Ensure mattress on bed supports
- Lose weight
What is non specific back pain?
there’s no obvious cause
What is mechanical back pain?
the pain originates from the joints, bones or soft tissues in and around the spine
What can back pain be a sign of?
- a broken bone in the spine
- an infection
- cauda equina syndrome
- some types of cancer, such asmultiple myeloma(a type of bone marrow cancer)
When would radio-frequency denervation be used?
- you’ve had back pain for a long time
- your pain is moderate or severe
- your pain is thought to originate from the joints in your spine
When is spinal fusion surgery recommended?
significant damage to the bones in your back (vertebrae)
What is somatic topic arrangement?
different areas of the body correspond to different areas on this somatosensory cortex of the brain
What is contralateral arrangement?
left side of this matter represents the right side of the body and the ride side of the somatosensory cortex represents the left side of the body
What can stimulation of the cingulate cortex cause?
aversion
What can stimulation of the insula cause?
vasoconstriction, sweating and increase in pulse rate
What can stimulation of the amygdala cause?
fear
What can stimulation of the reticular formation cause?
arousal
Where does touch decussation happen?
At medulla oblongata
Where do the neurones synpase?
- Medulla oblangata
- Thalamus
What is this. highway called for touch?
Dorsal medial lemniscus system
What do pain receptors need to initiate an action potential?
higher stimulus
What is transduction?
process by which a stimulus is converted to an action potential - the stimulus can be mechanical, thermal or chemical
Why do we feel pain at the site of inflammation?
- Chemoreceptors initiate an action potential in response to cytokines that are generally reeled at the site of inflammation
What tract does pain take?
Spinal thalamic tract
What are the two sub sections of the spinal thalamic tract?
- Fast (sharp pain)
- Slow (dull pain)
What is sharp pain carried by?
Adelta fibres
What is dull pain carried by?
c fibres
Why do the different fibres have different speeds?
different in thickness and myelination
Where do synapses occur in the spinothalamic tract?
dorsal horn of the spinal cord then to thalamus
Where does decussation occur in the spinothalamic tract?
dorsal horn
Where does the spinothalmic tract associate with?
- S2 region for visual integration
2. Insula that cause vasocontraction, sweating and increase in pulse rate
Where does dull pain synapse/travel to?
dorsal horn (where dessucates) and then to reticular formation and then AP goes to thalamus then to area of somatosensory cortex
Why does the reticular formation lead to staying awake?
eticular formation can lead to arousal and this is why slow dull pain can keep you awake
Where else is the AP taken in dull pain?
- cingulate cortex, which intimates a sense of aversion
- amygdala which initiates a sense of fear
What are red flags in cauda equina syndrome?
- Bilateral sciatica
- Severe of progressive bilateral neurological deficet of legs, such as major motor weakness with knee. extension, ankle eversion or foot dorsiflexion
- Difficulty initiating micturition or impaired sensation of urinary flow - if untreated this may lead to irreversible urinary retention with overflow incontinence
- Loss of sensation of rectal fullness, if untreated this may lead to irreversible faecal incontinence
- Perianal, perineal or genital sensory loss (saddle anaesthesia or paraesthesia)
- Laxity of anal sphincter
- Consider assessment of anal tone but notes does not need to be performed in primary care
What are some early warning signs for Cauda equina syndrome?
- Loss of feeling/pins and needles between inner thighs or genitals
- Numbness in or around your back passage or buttocks
- Altered feeling when using toilet paper to wipe yourself
- Increasing difficulty when you try to urinate
- Increasing difficulty when you try to stop or control your urine flow
- Loss of sensation when you pass urine
- Leaking urine or recent need to use pads
- Not knowing when your bladder is full or empty
- Inability to stop a bowel movement or leaking
- Loss of sensation when you pass a bowel motion
- Change in ability to achieve erection or ejaculate
- Loss of sensation in genitals during sexual intercourse
Is cauda equina a medical emergency?
yes, occurs when a patient suffers compression to the spinal nerve roots inside the dura, beyond the termination of the spinal cord
What is a common cause of cauda equina syndrome?
result of a prolapsed intervertebral disc, although rarely it can also be caused through infection or tumour
What can be some of consequences of delayed treatment for CES?
paralysis, incontinence and impaired mobility
What are red flags of CES?
- Pain that radiates below the knees bilaterally (on rare occasions this can be unilateral)
- Bilateral lower limb numbness or weakness
- Numbness either side of the buttocks and saddle area
- Bladder and/or bowel disturbance (including difficulty passing urine, poor stream, loss of sensation)
- Erectile dysfunction.
- Loss of anal tone or impaired sensation on per rectal (PR) examination.
