Intervertebral Disc Disease/Back Pain Flashcards
Low Back PAIN AFFECTS
80% of adults in US
- MJR CONTRIBUTOR to missed work days
-disability
Patho of back pain
due to musculoskeletal problem
Radicular pain
Irritation of nerve root
Referred pain
The source of pain is another location
Lumbar region
Bears most weight*
Is most flexible
Contains nerve roots
Has poor biochemical structure
Risk Factors of Low Back Pain
Lack of muscle tone*
Excess body weight*
Poor posture*
Cigarette smoking
Prior compression fractures*
Congenital spinal problems - scoliosis
Family history of back pain
Occupational Risk Factors for back pain
Repetitive lifting – nurses, construction
Vibration = truck driver
Extended periods of sitting - school
Health care personnel engaged in patient care
Chronic low back pain
Lasts longer than 3 months
Involves repeated incapacitating episode
often progressive
Various Chronic low back pain
Degenerative or metabolic disease
Weakness from scar tissue
Chronic strain
Congenital spine problem
Spinal stenosis
Narrowing of spinal canal
Spinal stenosis : Acquired conditions
Osteoarthritis, RA, tumors, trauma
Spinal stenosis : Inherited conditions
Congenital spinal stenosis – narrow spinal canal
scoliosis
Spinal stenosis s/s
Pain in low back and radiates to buttocks and leg
↑with walking/prolonged standing
Numbness, tingling, weakness, heaviness in legs and buttocks
Pain ↓ when bends forward or sits down
Spondylosis
Structural defect, forward displacement, heredity
Spondylolisthesis
Vertebrae slides forward
Graded 1-4 severity
Low Back Pain Overall Goals
Satisfactory pain relief
Return to previous level of activity
Correct performance of exercises
Adequate coping
Adequate self-help management
Low Back Pain Health Promotion
Proper body mechanics
“Back School program” – specific therapy for back
Appropriate body weight
Proper sleep positioning
Firm mattress*
Stop smoking
Weight reduction
Sufficient rest periods
Local heat and cold application
Physical therapy
Exercise and activity throughout day
Complementary and alternative therapies
Treat as outpatient if back pain is not severe
NSAIDs, muscle relaxants
Massage
Back manipulation
Acupuncture
Cold and hot compresses
If they have severe low back pain
corticosteroids
opioids
Low Back Pain Drug therapy
Mild analgesics
Antidepressants
Gabapentin (Neurontin)
Minimally invasive therapy for low back pain
Epidural corticosteroid injections
Implanted devices to deliver analgesia
Low Back Pain Nursing Dx
Acute pain
Impaired physical mobility
Ineffective coping
Ineffective health management
Intervertebral Disc Disease Patho
Intervertebral discs separate vertebrae and help absorb shock
Disease involves deterioration, herniation, or other dysfunction
Involves all levels
Degenerative Disc Disease Patho
Loss of elasticity, flexibility, & shock-absorbing capabilities
Disc becomes thinner as nucleus pulposus dries out → load shifted to annulus fibrosus → progressive destruction → pulposus seeps out (herniates)
Radiculopathy
Radiating pain
Numbness
Tingling
↓ Strength and/or range of motion
IDD S/S
Low back pain
Radicular pain
+Straight leg raise
↓ or absent reflexes
Paresthesia
Muscle weakness
Multiple Nerve root compression s/s
Severe low back pain
Progressive weakness
Increased pain
Bowel and bladder incontinence** quickly
Medical emergency
Cervical Disc Disease
Pain radiates to arms and hands
↓ reflexes and handgrip
May include shoulder pain and dysfunction
Higher the problem the more it affects the body
Check the strength before and after (better or worse)
Dx of Disc Diseases
X-rays
Myelogram, MRI or CT
Epidural venogram or discogram
EMG
Conservative Therapy
Start here 1st
Limitation of movement
Local heat or ice
Ultrasound and massage
Skin traction
Transcutaneous electrical nerve stimulation (TENS)
Back-strengthening exercises
Twice a day
Encouraged for a lifetime
Teach good body mechanics
Avoid extremes of flexion and torsion
Most patients heal in 6 months
Unless don’t follow lifestyle changes
Drug Therapy for Disc Diseases
NSAIDs
Short-term corticosteroids
Opioids
Muscle relaxants
Antiseizure drugs, antidepressants
GABApentin
Epidural corticosteroids injections
Surgery is indicated when IDD is debilitating
Conservative treatment fails
Radiculopathy worsens
Loss of bowel or bladder control
Constant pain
Persistent neurologic deficit
Intradiscal electrothermoplasty (IDET)
Minimally invasive outpatient procedure
Denervates nerve fibers
Radiofrequency discal nucleoplasty (coblation nucleoplasty
Needle inserted similar to IDET
Breaks up nucleus pulposus
Interspinous process decompression system
(X Stop)
To treat lumbar stenosis
Titanium: fits into mount placed on vertebrae**
Lifts vertebrae off pinched nerve
Laminectomy
Surgically remove disc through excision of part of vertebra
Discectomy
Surgically decompress nerve root
Microsurgical or percutaneous technique
Artificial disc replacement
Charité or Prodisc-L disc for lumbar DDD
Prestige cervical disc system
Surgically placed in spine through small incision after damaged disc is removed
Allows for movement at level of implant
Spinal fusion
Spine is stabilized by creating ankylosis (fusion) of contiguous vertebrae
Uses a bone graft from patient’s fibula or iliac crest or from donated cadaver bone
Metal fixation can add to stability
Bone morphogenetic protein (BMP) to
stimulate bone grown of graft
Nursing Management after back surgery
Vital Signs** RN job
Wound Inspection
Motor strength
Urinary retention voiding
Positioning (logroll)**
Home Care
PostOp spinal surgery
Opioids for 24-48 hours
Patient-controlled analgesia (PCA)
Switch to oral drugs when able
Muscle relaxants
Assess and document pain intensity and pain management effectiveness
Monitor GI and bowel function
Administer stool softeners**
Monitor and assist with bladder emptying
Loss of tone may indicate nerve damage
Notify surgeon immediately if bowel or bladder incontinence
CSF leakage after spinal surgery
Monitor for and report severe headache or leakage of CSF
Clear or slightly yellow drainage on dressing
+ for glucose
Frequently assess for peripheral neurologic signs
Teaching Post-Op spinal surgery
Proper body mechanics
Avoid prolonged sitting or standing
Encourage walking, lying down, shifting weight
No lifting, twisting
Use thighs and knees to absorb shock
Firm mattress or bed board
Baclofen (Lioresal)
used for spasticity
Baclofen (Lioresal) MOA
acts within the spinal cord to suppress hyperactive reflexes with no direct effects on skeletal muscle
Baclofen (Lioresal)
adverse effects
CNS effects, GI symptoms, urinary retention, *no antidote for overdose and withdrawal
also for severe MS
During logroll, who counts off when to move
Head of the bed
