Medical Management of LBP Flashcards
Radicular pain
- what causes it
- symptoms
- treatment
due to lumbar radiculopathy
–> can also lead to numbness and/or motor weakness
radicular pain due to:
- -> inflammation and vascular compromise OR nerve root compression
- -> stimulation of nociceptors in PLL & annulus
symptoms: sharp, shooting pain, leg pain worse than back pain, radicular and dermatomal pattern, possible sensory and motor impairments
treatment = conservative (PT, medication), injection or surgery
Epidural steroid injections
- rationale
- complications
- timeline
Rationale - direct localized anti-inflammatory
Complications
- direct needle trauma
- ischemic injury (injection into Artery of Adamciewicz)
- infection
- drug reaction
TImeline of injections: 3 over the course of 3-5 months w/ 4-6 weeks in between
Translaminar Approach
provides more spread of medication but which specific nerve roots it is spread to cannot be controlled as well
usually used if transforaminal approach cannot be used (stenosis, OA)
Approach from the midline, through LF to posterior aspect of epidural space
Transforaminal approach
Most common & most effective b/c directed at a specific nerve root by entering through the lateral foramen (subpedicular region)
can be technically difficult if severe degeneration or prior surgery/fusion
Caudal approach
very simple & least complicated way to access epidural space
cathedar can be threaded through needle to reach L5
provides a wider coverage
Spinal Cord Stimulation
Uses the gate control theory to minimze someone with chronic, severe LBP
electrically activating pain-inhibiting pathways in dorsal horn, providing a tingling sensation which will mask the sensation of pain
Contraindications: stenosis, infection, pregnancy, psychosocial problems, suppressed immune system
2 phases: trial and implantation
Differential Diagnosis for Lumbar Radiculopathy (3)
- Lumbar facet arthropathy
- Sacroiliitis
- Piriformis syndrome
Lumbar facet arthropathy
- clinical feature
- how to differentiate between LR
Clinical features:
- Lumbar axial pain, may refer to lower limbs
- frequently more pain w/ extension and lateral rotation
Diagnosis/differentiation:
- medial branch nerve block (the medial branch innervates the facet joint above & below the segment)
- if there is pain relief that is a POSITIVE response
- -> treatment = radiofrequency ablation
Sacroiliitis
- clinical features
- treatment
Clinical features:
- pain w/ referral along joint line to ipsilateral hip & trochanter
- can refer to posterior thigh (not past knee)
- similar symptoms to herniated disc
- pain w/ palpation
Treatment:
- PT
- SI injections
- Radiofrequency ablation of lateral branch nerves
- surgery: fusion of SI joint
Piriformis syndrome
- clinical features
- treatment
due to compression of sciatic nerve by piriformis muscle
clinical features:
- similar to L5/S1 radiculopathy (LBP/buttock to the knee)
- tender to palpation
- difficulty sitting
- reproduction of pain w/ stretching
Treatment:
- PT, NSAIDS, injection or surgery
