Low Back Pain and Sciatica

Question 1

How common is low back pain and recovery from it?

Answer 1

Very common 50-70% of people will have it

Most of time it resolves within 6 weeks

Question 2

Define non specific back pain

Answer 2

Pain not due to any specific or underlying disease that can be found

Question 3

Define mechanical back pain

Answer 3

Pain after abnormal stress and strain on the vertebral column

Question 4

Define nerve root pain

Answer 4

Pain radiating to the lower limbs with or without neuralgic symptoms

Question 5

What is the most common category of low back pain?

Answer 5

Mechanical (90%) of cases

Question 6

What are some ways mechanical low back pain arises?

Answer 6

Disc degeneration
Disc herniation
Annular tears
Facet joint OA 
Instability

Question 7

What are annular tears?

Answer 7

When the jelly leaks out into outer areas of the disc, chemicals cause back pain

Question 8

What is spondyloarthropathy?

Answer 8

Inflammatory joint disease eg ankylosing spondylosis

Question 9

How is spondyloarthropathy treated?

Answer 9

By strong biologics

Question 10

What is visceral low back pain?

Answer 10

Pain that appears to be back pain but is a result of something else eg pancreatitis or aortic dissection

Question 11

After history and physical examination what are indicators for sciatica?

Answer 11

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

Question 12

What imaging is recommended for low back pain and sciatica?

Answer 12

Imaging is not routinely offered, only offer if it is likely to change management

Question 13

What treatments are recommended by NICE for sciatica?

Answer 13

Exercise
Manipulation
Psychological therapy
NSAIDs
Weak opioids
Radiofrequency denervation
Epidural

Question 14

What are red flags for low back pain?

Answer 14

Weight loss
Fever
Night pain
Under 19 years 
Bowel or bladder dysfunction
Saddle anaesthesia
Profound neurological deficit

Question 15

What must you do if there are red flags present in low back pain?

Answer 15

Image straight away

Question 16

If imaging is needed in low back pain what is used?

Answer 16

Primarily MRI

Secondary is radiograph or CT

Question 17

What should you suspect as a cause of osteoporosis especially if someone is young?

Answer 17

Anorexia nervosa

Question 18

What are osteoid osteomas?

Answer 18

Tiny tumours that are very unpainful but have wider effects

Question 19

What treatments are available for pain therapy?

Answer 19

Physical therapy
Analgesia
Facet injections
Root block
Epidural injection
Neurostimulation

Question 20

What different types of facet injections are there?

Answer 20

Local
Steroid
Dernervation

Question 21

What approaches are there when giving facet injections?

Answer 21

Oblique and posterior