Low Back Pain And Sciatica

Question 1

Low back pain is pain in the _______________ area of the back.

Answer 1

lumbosacral

Question 2

If it is not associated with serious or potentially serious causes, low back pain is described as…? (4)

Answer 2

1. Non-specific
2. Mechanical
3. Musculoskeletal
4. Simple

Question 3

How long do episodes of back pain typically last?

Answer 3

Not long — rapid improvements in pain and disability seen within a few weeks to months

Question 4

Sciatica is characterized as ____________ pain or ___________

Answer 4

Radicular

Radiculopathy

**neuropathic leg pain secondary to compressive lumbosacral nerve root pathology

Question 5

Sciatica (radicular pain or radiculopathy) is neuropathic leg pain secondary to ______________ lumbosacral nerve __________ pathology.

Answer 5

compressive

root

Question 6

Sciatica can also be present in about 5–10% of individuals with ___________ back pain, and where they coexist, the symptoms of sciatica tend to predominate.

Answer 6

non-specific

Question 7

What are the non-drug treatments available for lower back pain with or without sciatica? (4)

Answer 7

1. Exercise programs
2. Manual therapy (spinal manipulation, mobilisation, soft-tissue techniques such as massage)
3. Psychological therapies
4. Spinal decompression (considered in patients when pain and function has not improved with non-surgical treatment including drug treatment)

Question 8

When is spinal decompression offered to patients with lower back pain with or without sciatica?

Answer 8

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

Question 9

Which drugs are considered first line for managing acute low back pain?

Answer 9

Oral NSAIDs

*taking into account the risks associated with NSAIDs, the need for continued monitoring, and the possible need for gastro-protective treatment

Question 10

What are the indications for the use of weak opioids in the management of acute lower back pain?

Answer 10

ONLY if an NSAID is contraindicated, not tolerated, or ineffective

Question 11

What is the role of paracetamol in treating acute lower back pain?

Answer 11

INEFFECTIVE for managing low back pain if used alone

Question 12

Do benzodiazepines have a role in the management of acute low back pain?

Answer 12

Sometimes used, particularly in loss of lordosis; however evidence to support their use is very weak

Question 13

In patients with chronic low back pain who have had an inadequate response to non-drug treatment, __________ should be considered as first-line therapy. ____________ should be the last treatment option considered and should be considered only in patients for whom other therapies have failed and only if the potential benefits outweigh the risks for individual patients.

Answer 13

NSAIDs

Opioids

Question 14

If indicated for the treatment of low back pain, opioids should only be prescribed for _________________. _______________ opioid therapy should be avoided

Answer 14

a limited period of time

Long term

Question 15

Which 5 drug classes should NOT be offered for managing low back pain?

Answer 15

1. SSRIs
2. SNRIs
3. TCAs
4. Gabapentinoids
5. Antiepileptic drugs

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, referral for __________________ can be considered.

Answer 16

radiofrequency denervation

Question 17

Are NSAIDs useful in the management of sciatica?

Answer 17

Limited evidence of benefit and risks associated with their use make prescription unadvisable

Question 18

What management options are available for patients with acute and severe sciatica? (2)

Answer 18

Epidural injections of…

1. Local anesthetic and/or
2. Corticosteroids