L12 - back pain Flashcards
function of the spine
- allows for a full range of movement
- protects spinal nerves
- acts as a shock absorber
- flexibility
curves in normal health spine (descending)
- cervical lordosis
- thoracic kyphosis
- lumbar lordosis
components of intervertebral discs
anulus fibrosis
nucleus pulposus
anulus fibrosis
touch, fibrous
nucleus pulposus
squidgy
trapped nerve
nucleus pulposus herniates
why does back become stiff with age
- discs lose water
- lose strength
- become thin
- tears due to repetitive loading
- weaker discs = slacker ligaments
- spine is less stable
- spine grows osteophytes
- increased load over facet joints
how does back pain result in muscle weakness and wasting
people are afraid to move because it hurts
key messages regarding a healthy back
keep flexible
keep strong
determinants of back pain
- genetics
- environment
- body weight
- muscle strength
- mechanical loading
risk factors for LBP at work
- Heavy physical jobs
- Lifting
- Driving to work
- Previous episodes of LBP
- Mental health
- Posture
LBP classification
- simple backache
- nerve route involvement
- possible serious spinal pathology
simple mechanical back pain history
- First episode often sudden onset while lifting/twisting/turning
- Recurrent episodes with decreasing inter-episode frequency
- Variable pain related to position/posture
- Better lying flat
- May radiate to buttock and leg
- Often worse at the end of the day and better with lying down/resting
what % of people over 65 show wear and tear / degenerative changes to their spine
100
examples of degenerative changes to spine with age
- facet arthritis
- disc narrowing
- osteophytes
early management of LBP
- Simple analgesics
- Physiotherapy
- Rest for no longer than 1-3 days
- Psychosocial management
- Work absence only if unavoidable
- Early return to work, possibly graded
when to consider secondary care for LBP
if >6 weeks
drug treatment for LBP
- paracetamol
- NSAIDs
- opiods
- anti-depressants
- nerve modulators
examples of opioids used for LBP
cocodamol
tramadol
morphine
examples of anti-depressants used for nerve pain
amitriptyline, duloxetine
examples of nerve modulators for LBP
gabapentin
pregabalin
sciatica
slipped disc at point of sciatic nerve
symptoms of sciatica
- pins and needles in leg
- numbness and weakness
- loss of ankle jerk
- foot drop
rheumatology back pain diagnoses
- Degenerative disease
- Axial Spondyloarthritis
- Osteoporosis
- Osteomalacia
- Paget’s disease
- Infection
- Tumour
red flag symptoms for back pain
- age at first onset
- history of carcinoma
- weight loss
- constant pain >1 month
- no response to treatment
- pain worse at rest
- history of IV drug abuse of HIV positivity
- infections
discitis
infection of spinal discs
which cancers metastasis to bone
breast lung prostate thyroid kidney
inflammatory back pain
- Insidious onset
- Nocturnal pain with marked early morning stiffness
- Better with exercise
- Worse with rest
- Family history
- Buttock pain
axial spondyloarthritis
inflammatory arthritis where main symptom is back pain
- affects younger people
- can result in spinal fusion
osteoporosis risk factors
- Age
- Female
- Smoking
- Steroids
- Alcohol
- Family history
- Inflammatory conditions
why is osteoporosis named the silent disease?
does not give you pain until you fracture
which area is most commonly affected by osteoporosis
lumbar spine
why are females more susceptible to osteoporosis
loss of oestrogen after the menopause
How is osteoarthritis prevented
HRT
Paget’s disease
abnormally shaped, brittle bones
- raised alkaline phosphatase
cauda equina syndrome symptoms
- difficulty with micturition (urinating)
- loss of anal sphincter tone / facet incontinence
- saddle anaesthesia
- LBP / leg pain
- degenerative arthritis
consequences of not treating caudal equine syndrome
- permanent lower limb paralysis
- sexual, bladder and bowel dysfunction
role of surgery in back pain
- Cauda equina syndrome
- Spinal stenosis
- (sciatica)
- Tumour/infection
- Instability
neoplastic / Infection history
- Insidious onset, sometimes subacute
- Slow deterioration
- 24 hr pain
- Weight loss
- Associated symptoms
- Sometimes fever (only sometimes though)
