Low back pain and sciatica

Question 1

Low back pain is pain in the (?) area of the back

Answer 1

lumbosacral

Question 2

What are the 4 categories of low back pain?

Answer 2

Non-specific
Mechanical
Musculoskeletal
Simple (not associated with serious or potentially serious causes)

Question 3

(?) (radicular pain or radiculopathy) is neuropathic leg pain secondary to compressive lumbosacral nerve root pathology

Answer 3

Sciatica

Question 4

Sciatica (radicular pain or radiculopathy) is (?) leg pain secondary to compressive lumbosacral nerve root pathology

Answer 4

neuropathic

Question 5

Sciatica (radicular pain or radiculopathy) is neuropathic leg pain secondary to (?) lumbosacral nerve root pathology

Answer 5

compressive

Question 6

What are the 4 types of non-drug treatment options for lower back pain?

Answer 6

1. Exercise programmes
2. Manual therapy (spinal manipulation, mobilisation, or soft-tissue techniques)
3. Psychological therapies
4. Spinal decompression (for sciatica when pain and function has not improved with non-surgical treatment)

Question 7

When is spinal decompression considered for treatment of sciatica?

Answer 7

When pain and function has not improved with non-surgical treatment (including drug-treatment)

Question 8

What is considered first-line drug therapy for chronic low back pain in patients who had an inadequate response to non-drug treatment?

Answer 8

NSAIDs

Consider possible need for gastroprotective treatment

Second line: weak opioid, either alone or with paracetamol

Question 9

If NSAIDs are contraindicated, not tolerated or ineffective to treat chronic low back pain, what is the second-line drug treatment?

Answer 9

Weak opioid, either alone or with paracetamol

Question 10

When are benzodiazepines particularly used in the management of acute low back pain?

Answer 10

Loss of lordosis

However, evidence to support their use is very weal

Question 11

Should SSRIs be offered for managing low back pain?

Answer 11

NO

Selective serotonin re-uptake inhibitors (SSRIs), serotonin and noradrenaline re-uptake inhibitors (SNRIs), tricyclic antidepressants, gabapentinoids, and antiepileptic drugs should not be offered for managing low back pain.

Question 12

Should SNRIs be offered for managing low back pain?

Answer 12

NO

Selective serotonin re-uptake inhibitors (SSRIs), serotonin and noradrenaline re-uptake inhibitors (SNRIs), tricyclic antidepressants, gabapentinoids, and antiepileptic drugs should not be offered for managing low back pain.

Question 13

Should tricyclic antidepressants be offered for managing low back pain?

Answer 13

NO

Selective serotonin re-uptake inhibitors (SSRIs), serotonin and noradrenaline re-uptake inhibitors (SNRIs), tricyclic antidepressants, gabapentinoids, and antiepileptic drugs should not be offered for managing low back pain.

Question 14

Should gapapentinoids be offered for managing low back pain?

Answer 14

NO

Selective serotonin re-uptake inhibitors (SSRIs), serotonin and noradrenaline re-uptake inhibitors (SNRIs), tricyclic antidepressants, gabapentinoids, and antiepileptic drugs should not be offered for managing low back pain.

Question 15

Should antiepileptic drugs be offered for managing low back pain?

Answer 15

NO

Selective serotonin re-uptake inhibitors (SSRIs), serotonin and noradrenaline re-uptake inhibitors (SNRIs), tricyclic antidepressants, gabapentinoids, and antiepileptic drugs should not be offered for managing low back pain.

Question 16

When non-surgical treatment is ineffective in patients with moderate or severe localised back pain arising from structures supplied by the medial branch nerve, you should consider referral for …(?)

Answer 16

Radiofrequency denervation

Question 17

Radiofrequency denervation should be considered for patients with moderate or severe localised pain arising from structures supplied by the (?) nerve (if non-surgical treatments are ineffective)

Answer 17

Medial branch

Question 18

Patients with acute and severe sciatica may benefit from treatment with (?) injections of a local anaesthetic and/or corticosteroid.

Answer 18

Epidural

Question 19

Patients with acute and severe sciatica may benefit from treatment with epidural injections of a local (?) and/or corticosteroid.

Answer 19

Anaesthetic

Question 20

Patients with acute and severe sciatica may benefit from treatment with epidural injections of a local anaesthetic and/or (?).

Answer 20

Corticosteroid