Lower Back Pain Flashcards
What are some likely causes for back pain?
Osteoarthritis (bone spur impingement)
Muscle strain
Hip joint problem
Sciatica (severe nerve pain rather than muscle pain)
Osteoporosis (bone crumbling can impinge nerves)
Slipped Disk
What is referred pain?
It is the sensation of pain in one region your body that is actually occurring in a different area completely?
What are some causes of referred back pain?
Disorder of large bowel
Dysmenorrhea
Renal condition
Prostate
Urinary tract infection
What are some patient factors that can worsen back pain?
Sedentary lifetstyle
Bursts of activity/improper lifting
Pregnancy
Poor posture
Bad Shoes
Excess weight
How many people that report back pain experience it chronically?
Up to 10% of cases
This can be due to strain on spinal column muscles, abdominal muscles, and glutes
Do most patients know what causes their back pain?
Most likely cannot recall a specific possible cause
MDs try to rule out red flags, it is harder to pin point a particular diagnosis though
What is the value of X-rays in back pain?
In cases without trauma, and X-ray may find minor damage due to just living for decades (irrelevant/misleading findings).
X-rays are usually not done at the get go in diagnostics. X-rays are performed later in the diagnostic process
Are NSAIDs useful in neuropathic pain (sciatic pain)?
No, refer to massage therapists and MD for better treatment option
What is the difference between neuropathic and nociceptive pain?
Neuropathic pain may be felt as burning or tingling (hitting funny bone)
Nociceptive pain is usually due to an injury (most pain is nociceptive (bumping your toe)
What is the first question pharmacists should ask a patient with back pain?
What have you tried? This can help us gauge what we can help with or what is going on with the patient
Is back pain a large part of a pharmacist’s professional duties?
No, this is for physiotherapists and MDs
What questions should pharmacists ask in patients with back pain?
How long has it been and how bad is the pain?
Is it just low in your back or higher (more severe) up too? Sore neck
Any chance this was due to a fall
IS the pain worse when lying down/sleeping?
Any numbness in bum area (if more than a few hours, seek medical attention)
Besides the pain, do you feel sick (fever, chills, weight loss)?
What are some red flags for referral in back pain?
Pain located high in spine (could be whiplash, Osteoarthritis, osteoporosis)
Trauma (fall from height)
Fever, shills, unexplained weight loss
Pain worse when lying down/sleeping
Numbness in bum area
Young kids vs. Elderly (kids shouldn’t have back pain)
Leg pain>back pain (could be sciatic)
Increasing pain
Steroid usage
What is good advise for when patients to see an MD if they have back pain without red flags?
See an MD after 5 days with no relief of general back pain
Do most cases of back pain go away on their own?
WIthin 30 days: 2/3 of cases resolved
WIthin 3 months: 90% of cases resolved
Chronic: about 10% of patients will have pain long-term and it will not go away on its own
Should pharmacists recommend exercise in back pain?
No, this is not our professional expertise. We need to refer to physiotherapists
There are some patients with back pain that will not benefit, or even be harmed by activity. These patients need to rest
What does our typical patient look like?
They do not have red flags
They are under 40
Have a long history with back pain (chronic)
Is acetaminophen useful in back pain?
No, even if it is marketed for back pain
Acetaminophen is not recommended for pain
What should a pharmacist do if a patient is adamant on using acetaminophen?
Advise them to use it for acetaminophen for 2 weeks and examine whether their back pain is better
What are some NSAIDs used in back pain?
ASA (up to 4g/day): has both analgesia and anti inflammatory
Ibuprofen (1200mg max OTC): analgesia, anti inflammatory not possible at OTC levels
Naproxen (440mg max OTC): analgesia, anti inflammatory is not possible at OTC levels
Do increasing doses of NSAIDs mean better pain control?
No at a certain point, increased dose does not increase analgesic effect
Unlike morphine
What patient profiles are we worried about when using NSAIDs?
Geriatrics
Cardiovascular
GI
Asthma
Renal
What is the utility of skeletal muscle relaxants?
Not very anti-spasmodic (not really used due to negligible benefit)
What is the common ingredient in the different Robax formulations?
Methocarbamol
What is the best Robax formulation for back pain?
Robax-isal (methocarbamol and ASA)
ASA mainly doing the heavy lifting anyway, methocarbamol along for the ride
What is the utility of heat or cold packs in back pain?
In acute cases, Cold is generally reccomended
If chronic, recommend heat (can be anti-spasmodic)
What is the utility of topical external analgesics (RUB-A535)?
They are counterirritants (methyl salicylate and menthol)
These agents fool the brain by irritating the skin above the irritated muscle. The brain stops perceiving the muscle pain less strongly
Efficacy in back pain is not very definitive
Voltaren is an NSAID, not an external analgesic
What is the efficacy of lidocaine in back pain?
Lidocaine does not get very deep into the skin.
It can be used with other external analgesics
Not a big player in LBP treatment
Should Zostrix be used in back pain?
No, only use for post-herpetic pain because the side effects are simply too severe (NSAIDs are better suited)
What is the efficacy of diclofenac?
It is a great NSAID product and it offers less side effects
Maybe DOC in patients over 75 due to low side effects and drug interactions
Used TID or QID (use an FTU)
What are some herbals that are effective in back pain?
Turmeric is the only one with merit for this indication
What is the indication for glucosamine?
It is an oral agent that is supposed to repair synovial joints (this is a herbal disease modification agent)
This mechanism is ineffective in back pain. Not an analgesic + there are no synovial tissues in the back
Is arnica herbal useful in back pain?
Nope, its dog water
What is the active ingredient in turmeric?
Curcumin, evidence supports use of 1g in arthritis
Why should pharmacists avoid recommending back braces for back pain?
We need to refer to physiotherapists, they can better examine patient.
We could risk making their back pain worse via improper technique or sizing
What is the efficacy of cyclobenzaprine?
It can be used for muscle spasm relief, works better than methocarbamol
Can cause drowsiness, dry mouth, and fatigue (decreased SNS)
What is the efficacy of antidepressants in back pain?
Amitriptyline was the go to product for neuropathic pain, but newer evidence suggests it is not the best
Are Dr. Ho’s pads effective in back pain?
They can stimulate the muscles and help with neck pain
