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brs (phase 1b) > (msk) back pain > Flashcards

(msk) back pain Flashcards

1
Q

what are the types of back pain?

A

non-specific lower back pain

mechanical lower back pain

nerve root pain (sciatica)

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2
Q

define non-specific lower back pain

A

pain not due to any specific or underlying disease that can be found

(could have pathological causes that are yet to be diagnosed)

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3
Q

define mechanical lower back pain

A

pain after abnormal stress and strain on the vertebral column

(pain associated w joint & limbs)

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4
Q

define nerve root pain

A

pain radiating to the lower limbs with or without neuralgic symptoms

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5
Q

what are the non-mechanical causes of lower back pain?

A

tumour including myeloma

infection

spondyloarthropathy

pars interarticularis injury

compression fracture

visceral (referred from abdomen e.g. dissecting aortic aneurysm, pancreatitis)

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6
Q

what are the mechanical causes of lower back pain?

A

disc degeneration

disc herniation

annular tears

facet joint osteoarthritis

instability

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7
Q

what are some possible visceral causes of lower back pain?

A

referred from abdomen e.g. dissecting aortic aneurysm, pancreatitis

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8
Q

why is imaging not routinely offered for lower back pain in a non-specialist setting?

A

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)

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9
Q

when is imaging usually offered for lower back pain?

A

in a specialist setting when conservative management has not improved the condition of the patient

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10
Q

why can imaging sometimes not be offered for lower back pain even in a specialist clinical setting?

A

the specialist may be able to work out the cause without needing imaging

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11
Q

when is imaging specifically indicated for lower back pain?

A

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

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12
Q

what conservative treatments are available for lower back pain?

A

analgesia (Paracetamol)

anti-inflammatory drugs

manipulation

acupuncture

massage

!! allow some time to pass !!

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13
Q

is bed rest recommended for patients with lower back pain?

A

no!

= does not result in a faster recovery; instead, try to keep the patient mobile

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14
Q

which are the most preferred treatments for lower back pain?

A

exercise (best one)

manipulation, psychological therapy

NSAIDs, weak opioids

radiofrequency denervation

epidural

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15
Q

which are the less preferred but reasonable treatments for lower back pain?

A

acupuncture

corsets, traction

paracetamol, opioids

ultrasound, TCNS (transcutaneous nerve stimulation)

injections

spinal fusion, disc replacement

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16
Q

what are some indicators of sciatica in the patient history?

A

unilateral leg pain greater than low back pain

pain radiating to the foot or toes

numbness or paraesthesia in the same regions

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17
Q

what are some indicators of sciatica in the clinical examination?

A

straight leg raising test induces more leg pain

localised neurology (limited to one nerve root)

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18
Q

what are the red flag symptoms of lower back pain?

A

weight loss

fever

night pain

under 19 years

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19
Q

what are the red flag symptoms of leg pain?

A

bowel/bladder dysfunction

saddle anaesthesia

profound neurological deficit (i.e. cannot move legs)

20
Q

why must lower back pain that appears pathological be diagnosed as quickly as possible?

A

delays in diagnosis cause paralysis and fractures

21
Q

why are spinal metastases dangerous?

A

can risk compression of the vertebral column an spinal cord that can lead to catastrophic fractures and paralysis respectively

22
Q

how do spinal metastases appear on a spinal MRI?

A

multiple deposits of different sizes in different parts

23
Q

which cancers most commonly metastasise to the spine?

A

breast, prostate, lung, bowel

24
Q

why must individuals under 35 years of age who experience back pain for more than 3 months have a spinal MRI?

A

may have inflammatory arthropathy
+
early diagnosis allows more effective treatment with biologics (prevents lifelong morbidity)

25
Q

does early detection help in treating spinal metastases?

A

not usually

= early diagnosis does not usually help with prognosis

26
Q

does early detection help in treating inflammatory arthropathy?

A

yes

= early treatment with biologics is said to be very effective and prevents lifelong morbidity

27
Q

does early detection help in treating spinal myeloma?

A

yes

= early diagnosis catches the disease at a more easily treatable stage

28
Q

why is tuberculosis of the spine dangerous?

A

1) subtle symptoms can be missed and this allows progression of disease
2) advanced disease can cause compress the spinal cord and cause paralysis

29
Q

does early detection help in treating tuberculosis of the spine?

A

yes

= early diagnosis is essential for effective treatment

30
Q

what is the primary method of imaging for lower back pain?

A

spinal MRI scan

less preferred = radiograph, CT scan

31
Q

why are radiographs not commonly used for imaging for lower back pain?

A

1) overlook most important diseases (e.g. metastases, myeloma)
2) radiation exposure

32
Q

how can Paget’s sarcoma cause lower back pain?

A

abdominal soft tissue can erode into vertebrae and cause compression of the spinal cord

33
Q

how can anorexia nervosa cause lower back pain?

A

aneroxia nervosa
= impaired nourishment
= osteoporosis

so there is an increased risk of vertebral compression fractures

34
Q

a 12-year-old presents with lower back pain

what should you do to investigate, and why?

A

do a spinal MRI

= can be due to adolescent disc prolapse (rare, but not impossible!)

35
Q

in which scenario do some MRI scans not pick up lesions?

A

in T2-weighted MRI scans

bony mets usually picked up on T1-weighted MRI scans

36
Q

what is an osteoid osteoma?

A

a benign bone tumour

37
Q

what are some specialist treatments for lower back pain?

A

(analgesia)

facet injections (local & steroid, denervation)

nerve root block

epidural injection

surgery/neurostimulation

38
Q

what are facet injections for lower back pain and why are they done?

A

injection of local anesthetic (numbing medicine) into a facet joint

1) to help diagnose the facet joints as the source of the patient’s pain
2) to provide pain relief

39
Q

how are facet injections administered for lower back pain?

A

using a 21g needle into the facet joint

one level at a time

inside/around the joint

40
Q

what do local facet injections contain?

A

marcain 0.5%, 1ml

41
Q

what do steroid facet injections contain?

A

trimcinolone, 20mg

42
Q

what is nerve root block for lower back pain?

A

injection of medication around the structure to block pain from specific nerves

43
Q

what are the types of nerve root block available?

A

CT-guided root block

MRI-US fusion root block (using VNav needle guidance)

44
Q

what are the three types of epidural steroid injections?

A

caudal
transforaminal
interlaminar

45
Q

which surgical options are available for lower back pain?

A

decompression of nerve roots

decompression of spinal stenosis

disc replacement

spinal fusion surgery

46
Q

at which week is imaging usually done for lower back pain?

A

red flag symptoms = done immediately

no red flag symptoms, but no improvement after 6 weeks of conservative management = imaging

brs (phase 1b) (71 decks)

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