clinical approach to back pain

Question 1

where is hip disease referred to?

Answer 1

The knee

Question 2

where is diaphragmatic irritation referred to?

Answer 2

the shoulder

Question 3

what Is the definition of mechanical back pain?

Answer 3

Pain secondary to overuse of a normal anatomical structure or pain secondary to trauma or deformity of an anatomical structure

Question 4

what are clinical features of mechanical back pain?

Answer 4

Otherwise well
age 20-55
varies with posture and activity

Question 5

what are clinical features of nerve root tension causing back pain?

Answer 5

unilateral leg pain> back pain
radiation to below knees
numbness and parathesia
signs of nerve irritability
motor, sensory and reflex changes

Question 6

what are clinical features of inflammatory back pain?

Answer 6

• more common in mals
• slow onset of symptom
• chronic
• morning stiffness that gets better with activity
• usually the axial skeleton
• extraskeletal features such as uveitis, CVS

Question 7

what clinical features can indicate serious spinal pathology?

Answer 7

constant, progressive and non mechanical
systemic symptoms of weight loss and unwell
- widespread nerve root signs
sphincter problems

Question 8

what is the general management of inflammatory back pain?

Answer 8

• education
• NSAIDS
  disease modifying drugs (methotrexate, sulphasalazine)

Question 9

what do you not offer in the NHS for back pain?

Answer 9

imaging in a non specialist setting
belt/corset orthotics
acupuncture
spinal injections
electrotherapy

Question 10

what medications do you not offer for back pain according to NICE guidelines?

Answer 10

SSRI’s
anticonvulsants
disk replacement
Opioids not for chronic back pain