Low Back Pain and Sciatica Flashcards
How common is low back pain and recovery from it?
Very common 50-70% of people will have it
Most of time it resolves within 6 weeks
Define non specific back pain
Pain not due to any specific or underlying disease that can be found
Define mechanical back pain
Pain after abnormal stress and strain on the vertebral column
Define nerve root pain
Pain radiating to the lower limbs with or without neuralgic symptoms
What is the most common category of low back pain?
Mechanical (90%) of cases
What are some ways mechanical low back pain arises?
Disc degeneration Disc herniation Annular tears Facet joint OA Instability
What are annular tears?
When the jelly leaks out into outer areas of the disc, chemicals cause back pain
What is spondyloarthropathy?
Inflammatory joint disease eg ankylosing spondylosis
How is spondyloarthropathy treated?
By strong biologics
What is visceral low back pain?
Pain that appears to be back pain but is a result of something else eg pancreatitis or aortic dissection
After history and physical examination what are indicators for sciatica?
Unilateral leg pain greater than low back pain
Pain radiating to foot or toes
Numbness and paraesthesia in the same distribution
Straight leg raising test induces more leg pain
Localised neurology—that is, limited to one nerve root
What imaging is recommended for low back pain and sciatica?
Imaging is not routinely offered, only offer if it is likely to change management
What treatments are recommended by NICE for sciatica?
Exercise Manipulation Psychological therapy NSAIDs Weak opioids Radiofrequency denervation Epidural
What are red flags for low back pain?
Weight loss Fever Night pain Under 19 years Bowel or bladder dysfunction Saddle anaesthesia Profound neurological deficit
What must you do if there are red flags present in low back pain?
Image straight away
If imaging is needed in low back pain what is used?
Primarily MRI
Secondary is radiograph or CT
What should you suspect as a cause of osteoporosis especially if someone is young?
Anorexia nervosa
What are osteoid osteomas?
Tiny tumours that are very unpainful but have wider effects
What treatments are available for pain therapy?
Physical therapy Analgesia Facet injections Root block Epidural injection Neurostimulation
What different types of facet injections are there?
Local
Steroid
Dernervation
What approaches are there when giving facet injections?
Oblique and posterior
