MSK 08: Mechanical Back Pain

Question 1

Phases

Answer 1

• acute (< 4 weeks)
• subacute (4-12 weeks)
• chronic (> 12 weeks)

Question 2

Spinal Stenosis

Answer 2

• degenerative arthritis affecting spine
• narrowing of spinal canal affecting nervous system function

Question 3

Degenerative Disc Disease

Answer 3

common and often natural degeneration of spinal column (asymptomatic)

Question 4

Cauda Equina Syndrome

Answer 4

impingement of bundle of nerves at base of spinal cord

• pain/numb/tingling
• spreading down from back to 1 or both legs
• impaired bowel/bladder function
• erectile or sexual dysfunction
• saddle numbness

Question 5

Ankylosing Spondylitis

Answer 5

(stiffening vertebra) form of arthritis

• autoimmune
• genetic factors
• prevalence varies between ethnicities
• can result in spinal fusion in time
• not improved by rest
• improved with exercise
• pain worse at night and morning
• unprovoked onset

Question 6

Red Flags

Answer 6

• cauda equina syndrome – loss of bowel or bladder control, saddle numbness
• infectious cause – fever, immunosuppression, IVDU history
• malignancy – cancer history, unexplained weight loss, night sweats
• risk of fracture – trauma to area, low bone density, previous fracture history
• autoimmune cause (ankylosing spondylitis) – predominant night/morning pain, improves with activity, age < 45

Question 7

Acute Treatment

Answer 7

(passive therapy)

• similar to neck injuries
• NSAIDs and acetaminophen
• no muscle relaxants, opioids, benzodiazepines

Question 8

Chronic Treatment

Answer 8

• similar to neck pain
• medications for/if sciatic pain or neuropathic involvement
• SNRI often used without neuropathic involvement or symptoms of depression
• NSAIDs and acetaminophen
• no muscle relaxants, opioids, benzodiazepines

Question 9

Long-Term Opioid Therapy (LTOT)

Answer 9

• not indicated
• not more effective than other analgesics

Question 10

Elderly Treatment

Answer 10

• anticholinergics: fall risk, cognitive impairment – cyclobenzaprine, methocarbamol, TCA’s, etc.
• sedative burden: fall risk, cognitive impairment – opioids, baclofen, gabapentin/pregabalin, anticholinergics
• dizziness or hypotension: fall risk – tizanidine, NSAIDs
• kidney damage: chronic kidney disease – NSAIDs, tizanidine, baclofen, gabapentin, pregablin

Question 11

MACS Prescribing

Answer 11

• NSAIDs only