Masqueraders - Spinal Pain Flashcards
Describe Visceral Referred Pain
vague, diffuse and associated with autonomic response
e.g. sweating, nausea, alarm reaction
Visceral pain can also result in central sensitisation
Causes hyperalgesia and sustained increase in muscle tone
When do we know that pain is not just simple LBP?
- Severe
- Refractory (i.e. does not respond to usual methods of pain relief/medication)
- Atypical in location or character
What are some Emergency conditions that look like LBP?
Dissecting aortic aneurysm
Ectopic pregnancy
Myocardial infarction
What are some Urgent conditions that look like LBP?
Acute pancreatitis
Duodenal ulcers
Pyelonephritis
Visceral trauma
What are Potentially serious conditions that look like LBP?
Cholecystolithiasis (gallstones) Endometriosis Fibroids Nephrolithiasis (kidney stones) Pelvic inflammatory disease Pregnancy Prostatitis Urinary tract infection
With back pain be on the lookout for warning signs such as:
- Significant neurological signs
e. g. Significant weakness, loss of bowel/bladder control, saddle paraesthesia - Significant abdominal tenderness/rebound tenderness (note location/intensity)
- Severe, focal pain associated with trauma
What is the pain like in a Dissecting Aortic Aneurysm ?
Tearing or ripping and is severe and intolerable with sudden onset
Describe how pain can reflect the location of a aneurysm?
Ascending aorta = Neck
Aortic arch = Anterior chest
Descending thoracic = Interscapular
Diaphragmatic hiatus/abdominal = Mid-back/thoracolumbar junction
What will we find on examination of DAA?
Palpation of the back and change in position does not alter the pain
Palpation of the abdomen may show a pulsatile mass and increase symptoms
Patients may also show a lack of pulses in the lower extremities
How does MI present in the spine?
MI is typically mid-thoracic and may radiate to the arm/axilla or jaw.
What are some Associated symptoms of MI?
Anterior chest heaviness ‘Crushing’ chest sensation Diaphoresis Dyspnoea, Nausea and vomiting
A sexually active female with severe lower back pain and abdominal discomfort may be suffering from an
Ectopic Pregnancy
What are the triad of symptoms in ectopic pregnancy?
- Missed period
- Vaginal bleeding
- Abdominal/lower back pain
How can trauma coz back pain if there is no musculoskeletal damage?
Pain referrals from viscera due to trauma
e.g. pancreatitis or retroperitoneal hematoma
A direct blow to the posterior flank may result in kidney damage
Look for haematuria and deep, constant, vague, aching pain
What condition has Pain which is typically deep and localised to the mid back (thoracolumbar region) or costal margin
Acute pancreatitis
