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NEUROLOGY > Low Back Pain & Sciatica > Flashcards

Low Back Pain & Sciatica Flashcards

1
Q

What should you ask a patient about onset of their back pain when taking a history?

A
  • Was it sudden?

- Have you noticed a trigger?

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2
Q

How may a patient describe the character of their back pain?

A
  • Dull

- Stabbing

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3
Q

Location and radiation of back pain is an indicator for the cause. TRUE/FALSE?

A

TRUE
e.g. if radiates to buttocks = muscular pain
If radiates to knee = more likely nerve pain

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4
Q

After how many months would back pain be considered chronic?

A

> 3 months

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5
Q

How should you ask about the intensity of a patients back pain (without using the 1-10 severity scale)?

A

Ask about what tasks it prohibits them from doing that they could do previously
e.g. climbing stairs

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6
Q

What associated symptoms should you always ask about in patients with back pain?

A 
Urinary symptoms
faecal symptoms (e.g. incontinence of both)
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7
Q

What factors can potentially aggravate patients back pain?

A
  • certain positions
  • coughing, sneezing (increases intrathecal pressure on nerve roots)
  • walking down stairs (due to walking on heel first)
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8
Q

What factors can relieve a persons back pain?

A
  • certain positions i.e. lying and standing usually better than sitting
  • non-pharmacological methods - physio chiropractor
  • analgesia
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9
Q

What should be asked about in the systems review to check for causes other than mechanical back pain?

A 
fever
weight loss
abdominal pain
cough/haemoptysis
dysuria/haematuria
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10
Q

What parts of a PMHx (including surgery) should you specifically ask about when a patient has back pain?

A
  • previous trauma
  • previous operations e.g. on spine
  • previous malignancy
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11
Q

What parts of the social history are important when patients present with back pain?

A
  • Occupation (type of work, level of activity during)
  • Smoking
  • Recreational drugs (e.g. steroids)
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12
Q

Back pain can be referred from elsewhere. TRUE/FALSE?

A

TRUE

=> always check that a patient’s back pain is not referred pain

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13
Q

What are the MAIN red flags of back pain?

A
  • Pain at night OR at rest
  • Failure of pain to improve after 4-6 weeks of conservative therapy
  • Motor or sensory deficit
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14
Q

What red flags of back pain and other risk factors may indicate cancer?

A

> 50 years old
unintentional weight loss
previous history of cancer
Night pain

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15
Q

What symptoms and risk factors would indicate back pain is due to an infection?

A
  • Fever/chills
  • Recent infection
  • Immunosuppression
  • IV drug use
  • Dental Status
  • Foreign Travel
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16
Q

What symptoms and risk factors would make you consider that a patients back pain is due to a fracture?

A

> 50 years old
osteoporosis (particularly females)
trauma
chronic steroid use

17
Q

What symptoms and risk factors indicate ower back pain is due to sciatica?

A
  • bilateral sciatica
  • urinary incontinence
  • leg weakness
  • Impaired anal tone
  • loss of perianal sensation
18
Q

What signs and symptoms may indicate an AAA causing lower back pain?

A

> 60 years old
pulsating mass
pain at rest

19
Q

What other tests should be completed alongside a spinal examination?

A 
Straight leg raise (testing hips)
Test muscle strength
Test sensation
Deep tendon reflexes
Standing on heels and then toes (whilst supported)
Lower limb assessment
20
Q

Investigations are often not required in patients with lower back pain. TRUE/FALSE?

A

TRUE

70-90% don’t require investigating as it will resolve with analgesia and activity

21
Q

Who should we X-Ray when they complain of back pain?

A

Young men - check SI joints for ankylosing spondylitis

Elderly patients - vertebral collapse, fracture, malignancy

22
Q

When is CT used to investigate back pain?

A

Limited use UNLESS RED FLAGS
=> looks for bone pathology- tumour, infection, trauma
Useful if MRI contraindicated

23
Q

When is MRI used to investigate back pain?

A
  • visualise soft tissue
  • If suspicious of a new fracture/ microfractures
  • shows bony oedema
  • *IF RED FLAGS USE MRI FIRST THEN CT**
24
Q

What is a radionuclide bone scan used to investigate in back pain?

A
  • Shows increased bone turnover (e.g. Pagets disease, Ankylosing Spondylitis)
  • Shows Tumours and metastases as these have increased cell turnover
25
Q

Why is a PET scan used in back pain investigation?

A

Increased uptake in areas of high turnover

- closest modality we currently have to imaging areas of pain

26
Q

What are lab tests used for in the context of back pain?

A

Rule out malignancy and infection

27
Q

What non-pharmacological treatments are used in back pain?

A
  • Explain/educate
  • reassure most is self-limiting
  • advice on activity/exercise
28
Q

What simple analgesia is often used in back pain management?

A

NSAIDs (useful for MSK pain, but unsuitable for many patients)
Opioids for breakthrough pain

29
Q

What Injections can provide relief in back pain?

A

Facet joint injections

Epidural blocks

30
Q

What complementary/alternative therapy is sometimes used in back pain?

A 
acupuncture
chiropractor
osteopath
massage
PHYSIO
31
Q

When should you begin to investigate a patient with back pain?

A

If no improvement after 4-6 weeks of conservative management

32
Q

When should back pain be referred?

A

intractable pain
serious pathology suspected
neurological deficit

33
Q

What are the risk factors for mechanical back pain?

A

Previous episode of back pain
heavy lifting / frequent bending
repetitive work
exposure to vibration (construction work)

34
Q

How can back pain be prevented?

A

Education on lifting/turning with heavy objects
Mental coping strategies for pain
Smoking cessation

35
Q

Other than mechnical back pain, what differentials could be causing a patients back pain?

A

Root compression due to degenerative disease
Sinister causes (Tumour, TB)
Compression outside of spine (e.g. endometriosis)
No root compression (peripheral neuropathy)

36
Q

What is piriformis syndrome and what nerve does it affect?

A

Condition where sciatic nerve runs WITHIN piriformis muscle

=> when muscle contracts patient experiences sciatic pain

37
Q

Sciatica is generally self-limting. TRUE/FALSE?

A

TRUE

NEUROLOGY (29 decks)

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