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PHAR 154 > Low Back Pain > Flashcards

Low Back Pain Flashcards

1
Q

How common is back pain?

A

Very common

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2
Q

What is back pain likely due to?

A

Osteoarthritis
Muscle Strain
Hip Joint Problem
Sciatica
Osteoporosis
Slipped Disk

realm of MD, physio and chiropractor

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3
Q

Describe what an osteoarthritic spine?

A
  • Bone Spurs
  • Narrowed disks
  • Knee/hand joints likely have OA to
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4
Q

What is responsible for lower leg numbness?

A
  • Sciatica nerve firing at the wrong time
  • Numbness from the lower back down the whole leg
  • NSAID’s are not good for neuropathic pain
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5
Q

Signs of Osteoporosis

A
  • Shortened height
  • Stooped or hunched over
  • Have developed back pain
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6
Q

With increased age, what is common?

A

Compression fractures are common with age

See abrupt onset of back pain, but many can be asymptomatic

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7
Q

Conditions for referred pain in the back area?

A

disorder of large bowel
dysmenorrhea
renal condition
prostate
urinary tract infection

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8
Q

What is the etiology/common causes of back pain?

A

Sedentary Lifestyle
Bursts of activity/improper lifting
Pregnancy
Poor Posture
Bad Shoes
Excess Weight

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9
Q

Is the cause of back pain usually identified?

A

NO

  • most likely cannot recall a specific possible cause
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10
Q

Chronic low back pain may be due to what muscles….

A

Spinal Column muscles
Abdominal Muscles
Glutes

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11
Q

What are two major causes of back pain?

A

Inactivity and heavy lifting

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12
Q

Is there a psychological aspect of back pain?

A

Pain Amplifier - If think will not get better, make things worse

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13
Q

Is the cause usually idetnfied?

A

No –> MD’s rule out red flags

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14
Q

Are X-rays useful for back pain?

A

No

X-rays find stuff. In the analysis of this stuff, as backs get older, you will find things (kinicks and bruises but the vats majority is not the reason for the pain)

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15
Q

What is the risk of X-rays? When should they be used?

A

Substantial risk of uncovering irrelevant misleading findings

If Red Flags are absent, delay radiology until 6th week of conservative (inc drug) management

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16
Q

What are the sx of lower back pain?

A

tightness in lower back / muscle spasm (bodys way of protecting from injury)

difficulty bending, moving, sitting

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17
Q

Questions to ask:

A

How long has it been?
When worse? Better?
Shooting?
Dull?
Constant?
Back pain vs leg pain?
Any numbness?

  • Not helpful to us. Do not get the chance to reproduce
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18
Q

In chronic cases, the pain origin is more likely….

A

Neuorpathic –> NSAID will not work

Nociceptive –> NSAID may work

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19
Q

What is neuropathic pain?

A

Damage to or dysfunction of the nerves
- Burning or tingling
- Ruptured intravertebral disk

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20
Q

What is nociceptive pain?

A

Injury to body tissues
- Most pain is nociceptive
- Aching, sharp, or throbbing

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21
Q

Sciatica is what type of pain? Are NSAIDs useful?

A

Sciatica = neuropathic

NSAIDs and opitaes are not that great of agents

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22
Q

What is one question that is very important to ask about back pain?

A

What have you tried so far?

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23
Q

Are most cases a serious medical problem?

A

NO

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24
Q

What is a pharmacists role in back pain?

A

Safe med use

  • Recommend phsyio and massage
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25
Q

Red Flags. When to refer?

A

Pain located high in spine (beyond a sore neck) - 2 days

Trauma (esp. fall from height) - ASAP

fever, chills, unexplained weight loss - ASAP

Pain worse when laying down/sleeping - 2 days

Numbness in bum area - ASAP

Bladder/Bowel Dysfunction - ASAP

Young Kids/Elderly - Make appt (chronic), 2 days for acute

Leg > back Pain - Make appt

Increasing pain - 2-7 days

Oral steroid usage - ASAP

No TIGERS FIND LIONS, NOTHING BEATS ALPHA LIONS IN OHIO

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26
Q

One red flag has a what % chance of being something serious?

A

10%

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27
Q

What should a patient try to fix first?

A

How to Sleep/Stand

Balance of back/abdom muscles (spine moves in direction of stronger muscles)

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28
Q

How does the spine move?

A

The spine moves in direction of the stronger muscles

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29
Q

When do cases of back pain get better?

A

Most get better on their own –. Most resolved by 3 months

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30
Q

How much rest should a person have post-injury?

A

Rest - Old thinking

Return to Normal Activities - Current thinking (may seem counter-intuitive to most pt’s)

Exercise –> Not our domain

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31
Q

What is a typical patient of back pain?

A

Not have any red flags
Will be >40
Long history of back pain

32
Q

Acet Back Pain

A

Analgesia, but not anti-inflamm

Not efficacious for back pain

33
Q

ASA for Back Pain

A

Not common, but a very good agent
- ASA brings it at OTC doses, the other guys do not

Analgesia and anti-inflammatory

34
Q

Ibu for Back Pain

A
  • Analgesia
  • Questionable for anti-inflammatory at OTC doses
35
Q

Naproxen for Back Pain

A
  • Analgesia
  • Questionable for anti-inflamm at OTC doses
36
Q

To achieve anti-inflammatory actions of NSAID’s, one needs

A

HIGHER DOSES –> RX territory

37
Q

What is often used in patients?

A

Stronger prescribed NSAID’s are often used in many patients

38
Q

What are skeletal muscle relaxants?

A

Sedation –> Not well known

  • Sedation in brain; not in muscles
  • Do not appear to be anti-spasmodic
39
Q

What are s/e of muscle relaxents?

A

CNS s/e (sedation, dry mouth, constipation)

40
Q

Are muscle relaxents useful?

A

NOT EFFECTIVE

41
Q

Example of Muscle Relaxent and Product

A

Methocarbomol - Robax

42
Q

What are some muscle relaxents? Do we care which ones?

A

Methocarbamol
Chlorzoxazone
Orphenadrine
Methocarbamol

Do not care which one. All bad.

43
Q

As a pharmacist, we should recommend (oral stuff)

A

Plain analgesic (main)
Muscle relaxent (No)
Combo (if pt wants, need analgesic in there)

44
Q

Does the muscle aches and body pain label have different ingredients?

A

No –> if pt says works for them, good enough

45
Q

What is another thing we should recommend as pharamacists?

A

Heat and cold

46
Q

When should cold be used?

A

First 48 hours

47
Q

In the first 48 hours ______ should used

A

Cold

48
Q

If chronic or recurring episode of low back pain ______ is recommended. What is its benefit?

A

Heat

Heat can be anti-spasmodic

49
Q

Cold should be used for…..

A

Acute Injury

50
Q

Heat should be used for…..

A

Chronic Injury

51
Q

How many times a day should heat be used?

A

2-3 times a day for however long you can

  • Every 2-3 hours
52
Q

What is the MOA of topical external analgesics?

A

Counter-irritation
Massage/blood flow
Psychological (odour)

53
Q

Is voltaren a topical external analgesic?

A

NO

54
Q

Where are external topical analgesics more effective at?

A

More effective on larger muscles and sore muscles rather than back pain

55
Q

What are the two agents in external topical analgesics?

A

Methyl Salicylate

Menthol

56
Q

How does menthol work?

A

First 1/2 –> menthol hits cool receptors (not actually lowering temp)

After 1/2 hour –> Becomes warmth

57
Q

What is the % of menthol for what purpose?

A

<1% - anti-itch

> 1% - Counter irritant

58
Q

What is an important counselling tip to tell a patient with topical external analagesics?

A

Don’t use a heating pad at same time with any of these products!

59
Q

Is lidocaine used for back pain?

A

No –> Numbing agent
Does not get deep into the skin

60
Q

What is used for neuropathic pain? Is it useful?

A

Capsaicin

  • Gnerally for post-herpetic neuralgia (post-shingles)
  • Needs continous use to decrease substance P
  • Irritating when applied
61
Q

DOC for Back Pain

A

Topical Diclofenac

1% - TID or QID
Extra Strength - BID
May be drug of choice in patients > 75 yo if not younger

62
Q

What is the algorithm for back pain?

A

Topical Diclofenac
Standard (Oral)
Rub A535

63
Q

Topical diclofenac has more proof for….

A

More proof for OA knee and hand than back area

64
Q

Topical Diclofenac vs. NSAID’s

A

Less side effects than oral NSAIDs. Little systemic absorption

65
Q

Topical Diclofenac Amount to Use

A

1 FTU

66
Q

What is the only herbal that may be useful for back pain?

A

Tumeric

67
Q

is glucosamine useful for back pain?

A

NO

  • A disease modifying agent –> Only works on synovial joints
  • No synovial joints in the back
68
Q

Is tumeric the actual agent or not?

A

Curcumin –> Active ingredient
Turmeric –> Delivery device

69
Q

What is the amount of curcumin used for releif of pain in arthritis?

A

1-2 g

70
Q

Are back braces useful for back pain?

A

In 2-3 weeks, gait may be changed that can cause wrong relaxation of the wrong muscles
If walking around, should be unsinched –> will not affect the gait if unsinched

71
Q

Are opiods good for back pain?

A

NO

72
Q

What is cyclobenzaprine?

A
  • Blocks nerve impusles
  • MD realm not us
  • Relief of muscle spasms
73
Q

Cyclobenzaprine Length of Usage

A

Short periods (up to two or three weeks)

74
Q

What are some s/e of cyclobenzaprine?

A

Drowsiness, dry mouth, fatigue

75
Q

Antidepressants use in Low Back Pain

A

Amitryptyline –> Neuropathic Pain

  • SNRI’s and TCA’s

PHAR 154 (6 decks)

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