Low Back Pain Flashcards by Becky Monaghan

What percentage of the UK population will experience low back pain in their lifetime?

Up to 60%

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What percentage of adults under the age of 45 have chronic low back pain?

3-4%

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What percentage of adults over the age of 45 have chronic low back pain?

5-7%

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What accounts for 90-95% of cases of low back pain presenting in primary care?

Non-specific low back pain

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What are the risk factors for the development of chronic low back pain and disability?

Pain lasting longer than 12 weeks
High baseline pain intensity
Anxiety and/or depression
Stressful life events
Substance misuse
Maladaptive coping strategies
‘Fear and avoidance’

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Which group of people are most likely to experience low back pain?

Women and people aged 20-65

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What are the ‘red flag’ symptoms of low back pain?

Sphincter disturbances
Paraesthesia
Progressive weakness
Gait disturbances

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What are some history factors to ask about in a patient with low back pain?

Trauma, malignancy, neurological conditions, inflammatory conditions, steroid use, IV drug use (red flag histories)

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What are the key motor or sensory disturbances to ask about in low back pain?

Radiculopathy or cord compression symptoms (urinary retention or incontinence)

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What symptoms may indicate renal tract issues or malignancy?

Haematuria

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What sign may indicate inflammatory arthritis (such as rheumatoid arthritis or ankylosing spondylitis) with low back pain?

Early morning stiffness

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What is the typical presentation for a lumbar strain or sprain?

Pain that improves with rest

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What condition is indicated by lower back pain that worsens with prolonged sitting?

Lumbar disc disease, spondylosis

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What condition is indicated by lower back pain that worsens with valsalva?

Lumbar disc disease

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What posture should be checked when a patient is standing during a low back pain physical examination?

Cervical lordosis, thoracic kyphosis, lumbar lordosis and any asymmetry or muscle wasting

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What deformity is associated with ankylosing spondylitis?

A ‘question mark’ spine - characterised by exaggerated thoracic kyphosis and loss of lumbar lordosis

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How should you palpate the lower back during a physical examination?

Palpate over the spinous processes, sacroiliac joints and paraspinal muscles, checking for tenderness or increased tone

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What movement tests should be performed in a patient with low back pain?

Lateral flexion, lumbar flexion/extension, cervical and thoracic flexion/extension and rotation tests

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What is Schober’s test used to assess?

Lumbar flexion - limited increase in distance between two marked points indicates abnormal lumbar movement

How is the straight leg test performed?

Patient lying flat - lift the extended leg to assess for pain, checking for sciatic nerve irritation

What is the gate control theory of pain?

Pain signals are modulated by ‘gates’ in the spinal cord that can be opened or closed by physical, emotional and mental factors

What factors tend to open the ‘gates’ in the gate control theory?

Stress, anxiety, focusing on pain, boredom, inactivity

What factors help to close the ‘gates’ and reduce pain perception?

Relaxation, optimism, mental engagement and physical activity

What role does mental focus play in the gate control theory?

Concentrating on something other than pain can close the gates, while focusing on pain can open them and worsen the perception

What is the purpose of the STarT back tool?

Categorises patients' risk for chronic low back pain, enabling the assignment of appropriate treatment packages

What are the 3 risk categories used in the STarT back tool?

Low, medium and high risk

What type of treatment is recommended for patients identified as low risk using the STarT back tool?

Self-management, reassurance and medication

What factors increase the risk of long-term disability and time lost from work in a patient with low back pain?

Pain lasting longer than 12 weeks, high baseline pain intensity, anxiety/depression, stress, substance misuse and maladaptive coping strategies

What psychological factors are linked to an increased risk of disability from low back pain?

Anxiety, depression and catastrophising

How can the perception of persistent pain affect recovery?

It can hinder recovery and contribute to chronic disability

What are the main non-pharmacological interventions for managing low back pain?

Education, exercise, manual therapies (spinal manipulation/massage) and psychological therapy (e.g CBT)

How does exercise contribute to the management of low back pain?

It helps improve fitness, reduces stiffness and promotes movement which can alleviate pain

What psychological therapy is often used for back pain management?

CBT - addresses negative thoughts and behaviours related to pain

How does MRI help in assessing spinal anatomy in patients with low back pain?

MRI helps identify abnormalities such as disc protrusions, vertebral metastases and lytic or sclerotic lesions in the spine

How do you identify T1 vs T2 weighted MRI?

T1 highlights fat while T2 highlights fat and water

What is the role of gadolinium contrast in MRI imaging?

Enhances vasculature and pathologically vascular tissues (e.g. metastases, meningiomas)

What is STIR imaging used for in spinal MRI?

Short Tau Inversion Recovery - nullifies the fat signal, helping to highlight soft tissue abnormalities like inflammation or oedema

What is FLAIR imaging used for in spinal MRI?

Fluid Attenuated Inversion Recovery - nullifies CSF signal making it useful for identifying lesions in the brain and spine

What is a lytic lesion and how is it seen on MRI?

A lytic lesion is a decrease in bone density, appearing as a high-signal area on MRI scans and low signal on CT scans

What is a sclerotic lesion and how does it appear on MRI?

A sclerotic lesion is an area of increased bone density, appearing as a low-signal area on MRI scans and high-signal on CT scans

When should MRI be considered in the diagnosis of low back pain?

When there are 'red flag' symptoms such as severe neurological deficit, urinary incontinence/retention, significant trauma or suspicion of cancer or infection

What is the first line treatment for acute low back pain?

Rest, activity modification, pain relief (e.g. NSAIDs) and physical therapy exercises

When should opioids be considered for treatment of low back pain?

Opioids should only be considered when other treatments fail, and for the shortest duration possible

How does physical inactivity contribute to low back pain?

Can lead to weakened muscles, poor posture and decreased flexibility which all contribute to increased strain on the back

What role does obesity play in the development of low back pain?

Obesity increases stress on the spine and muscles, leading to a higher risk of developing low back pain, especially through mechanical overload