(msk) back pain Flashcards
what are the types of back pain?
non-specific lower back pain
mechanical lower back pain
nerve root pain (sciatica)
define non-specific lower back pain
pain not due to any specific or underlying disease that can be found
(could have pathological causes that are yet to be diagnosed)
define mechanical lower back pain
pain after abnormal stress and strain on the vertebral column
(pain associated w joint & limbs)
define nerve root pain
pain radiating to the lower limbs with or without neuralgic symptoms
what are the non-mechanical causes of lower back pain?
tumour including myeloma
infection
spondyloarthropathy
pars interarticularis injury
compression fracture
visceral (referred from abdomen e.g. dissecting aortic aneurysm, pancreatitis)
what are the mechanical causes of lower back pain?
disc degeneration
disc herniation
annular tears
facet joint osteoarthritis
instability
what are some possible visceral causes of lower back pain?
referred from abdomen e.g. dissecting aortic aneurysm, pancreatitis
why is imaging not routinely offered for lower back pain in a non-specialist setting?
1) lower back pain is an extremely common presentation
2) likely to improve on conservative management within the first 6 weeks so imaging not usually indicated (unless red flag symptoms)
when is imaging usually offered for lower back pain?
in a specialist setting when conservative management has not improved the condition of the patient
why can imaging sometimes not be offered for lower back pain even in a specialist clinical setting?
the specialist may be able to work out the cause without needing imaging
when is imaging specifically indicated for lower back pain?
in a specialist setting when
1) conservative management has not worked to improve the patient’s condition
2) if imaging is likely to change the management of the patient
what conservative treatments are available for lower back pain?
analgesia (Paracetamol)
anti-inflammatory drugs
manipulation
acupuncture
massage
!! allow some time to pass !!
is bed rest recommended for patients with lower back pain?
no!
= does not result in a faster recovery; instead, try to keep the patient mobile
which are the most preferred treatments for lower back pain?
exercise (best one)
manipulation, psychological therapy
NSAIDs, weak opioids
radiofrequency denervation
epidural
which are the less preferred but reasonable treatments for lower back pain?
acupuncture
corsets, traction
paracetamol, opioids
ultrasound, TCNS (transcutaneous nerve stimulation)
injections
spinal fusion, disc replacement
what are some indicators of sciatica in the patient history?
unilateral leg pain greater than low back pain
pain radiating to the foot or toes
numbness or paraesthesia in the same regions
what are some indicators of sciatica in the clinical examination?
straight leg raising test induces more leg pain
localised neurology (limited to one nerve root)
what are the red flag symptoms of lower back pain?
weight loss
fever
night pain
under 19 years
what are the red flag symptoms of leg pain?
bowel/bladder dysfunction
saddle anaesthesia
profound neurological deficit (i.e. cannot move legs)
why must lower back pain that appears pathological be diagnosed as quickly as possible?
delays in diagnosis cause paralysis and fractures
why are spinal metastases dangerous?
can risk compression of the vertebral column an spinal cord that can lead to catastrophic fractures and paralysis respectively
how do spinal metastases appear on a spinal MRI?
multiple deposits of different sizes in different parts
which cancers most commonly metastasise to the spine?
breast, prostate, lung, bowel
why must individuals under 35 years of age who experience back pain for more than 3 months have a spinal MRI?
may have inflammatory arthropathy
+
early diagnosis allows more effective treatment with biologics (prevents lifelong morbidity)
