Mechanical lower back pain Flashcards
Describe the disease course of mechanical lower back pain.
Starts suddenly, often precipitated by injury (e.g. lifting heavy boxes at work), usually self-limiting, may be recurrent.
When does the pain happen if it is caused by mechanical lower back pain?
Sudden onset
Worse in evening or on exercise
No morning stiffness
When there is a visible muscle spasm in the lower back, the pain is generally better when..
sitting or lying
List 3 risk factors for chronic pain.
‘Yellow flag’ psychosocial factors.
Also:
Female sex, middle age, low household income, divorced, low educational status.
List 3 of the ‘yellow flag’ psychosocial risk factors for developing persisting chronic pain.
Belief that pain and activity are harmful.
Sickness behaviours e.g. extended rest.
Social withdrawal.
Emotional problems e.g. low mood, anxiety or stress.
Problems at work.
Problems claiming compensation/time off from work.
Overprotective family or lack of support.
Inappropriate expectations of treatment.
List 5 red flag features of mechanical lower back pain that would prompt you to investigate it.
Aged 20-55.
If pain is constant, progressive.
Worse when supine.
Morning stiffness.
Bilateral/alternating leg pain (cauda equina!)
Ynrelieved by rest, night pain, thoracic pain.
PMHx of TB, HIV, immunosuppression, infection, malignancy.
Fever, night sweats, weight loss, abdominal mass, neurological disturbance, leg claudication/weakness/numbness, major trauma.
Mnemonic for red flags for back pain.
TUNA FISH:
> Trauma - osteoporosis
Unexplained weight loss - cancer
Neurological symptoms - cauda equina syndrome
Age > 50 or < 20 - secondary bone cancer, ankylosing spondylitis, herniated disc
> Fever - infection
IV drug use - infection
Steroid use - infection
History of cancer - cancer metastasised to the spine
Give 3 signs you may see on examination of a patient with mechanical lower back pain.
Scoliosis.
Stiff back.
Visible and palpable muscular spasm, causing local pain and tenderness.
When would you do a spinal X-ray in lower back pain?
When there is red flags e.g.
- Nocturnal pain
- Leg pain
- Sphincter disturbance
- Violent trauma
How would you manage a patient with mechanical lower back pain if there was no sinister cause?
Adequate analgesia - paracetamol, codeine.
Avoid bed rest - encourage exercise and physiotherapy.
Give a differential for lower back pain with no obvious cause or red flags.
Polymyalgia rheumatica:
- Muscle ache affecting the shoulders, arms, hips, neck.
- Will have a raised ESR + CRP.
What is an intervertebral disk made up of?
Outer fibrous : annulus fibrosis
Inner gel like : nucleus propulsus - becomes dehydrated over time
What part of the spine is usually affected by vertebral disk degeneration?
Lumbar
How does vertebral disk degeneration present?
Shooting pain
Sudden onset
Radiates to arms/legs
Muscle spasm
Tingling / parasthesia / numbnesss
Symptoms of L4 (L3-L4) lesion?
Thigh to calf pain
Loss of knee jerk
