MSK - Back pain

Question 1

What is sciatica?

Answer 1

Nerve root pain, pain radiates to lower limbs with or without neuralgic symptoms

Question 2

What are some causes of mechanical back pain?

Answer 2

• Disc degeneration
• Disc herniation
• Annular tears
• Instability

Question 3

What are the symptoms of sciatica?

Answer 3

• Unilateral leg pain greater than the back pain
• Same leg raising test induces more leg pain as nerve is being stretched
• Localised neurology, limited to one nerve root

Question 4

What are the NICE guidelines for referring a patient with back pain to get imaging done?

Answer 4

• Dont offer imaging in a non-specialist setting for back pain with or without sciatica
• Explain that if the patient is being referred for a specialists opinion, they may not need imaging
• Consider imaging in specialist settings of care for people with low back pain, with or without sciatica only if the result is likely to change management

Question 5

What is the conservative treatment for low back pain?

Answer 5

• Analgesia
• Anti-inflammatory drugs
• Manipulation (chiropractor/physio)
• Acupuncture (no harm, could work)
• Massage (helps muscle spasms, not underlying disease)
• Allow time to pass

Question 6

What are the red flag signs for low back pain?

Answer 6

• Weight loss
• Fever
• Night pain (could be malignancy)
• Under 19 yrs

Question 7

What are the red flag signs for leg pain?

Answer 7

• Bowel or bladder dysfunction
• Saddle anaesthesia
• Profound neurological deficit

Question 8

What is the primary imaging tool used for low back pain?

Answer 8

MRI