Pain: Lower Back Pain Flashcards
what regions are included in lower back pain?
what can the pain be associated with (3)
Spinal/paraspinal pain symptoms in lumbosacral
region; may include gluteal muscle, hips & lower
extremities
non‐specific low back pain, low back pain associated with radiculopathy (e.g., sciatica) or spinal stenosis, or low back pain associated with other specific spinal causes
Radiculpopathy results from dysfunction of nerve root
risk factors (6)
when can injury occur?
◦ Age (45‐64)
◦ Greater height
◦ Climbing stairs often
◦ Stress
◦ Smoking & obesity
◦ Spinal causes
- Referred visceral pain from endometriosis
injury occurs with frequent walking/standing, lifting or carrying
red flags - SEE RXTX FOR MORE
possible fracture
- major/minor trauma, if older age or CTS use
red flags
possible tumor/infection - when to refer
- age <20 or >50
- history of cancer
- systematic: fever, weight loss, chills
- risk factors for spinal infection (recent bacterial immunosuppression, indwelling catheter)
- pain worse in supine position, severe nighttime pain
red flags
possible cauda equina syndrome - characteristics?
Nerve roots of cauda equina are compressed and disrupt motor and sensory func in lower extremities and bladders
- saddle anesthesia
- bladder dysfunc
- severe/progressive neuro dysfunc in legs
- lax anal sphincter
- major motor weakness: quadriceps, ankle plantar flexors, extensors, dorsiflexors
red flags
other
- history of it
- comorbid psychiatric conditions
- failure of conservative treatment
- no association w/ activity
- activity intolerance
- persistent pain > 4 WKS
- sciatica symptoms
FYI sciatica
Sciatica: mild ache to sharp burning sensation (varies) or excruciating pain
- Usually only 1 side is affected - Numbness, tingling, weakness in affected leg or foot
Goals of Therapy (3)
Relieve Symptoms
Maintain or improve mobility & quality of life
Prevent or minimize re‐injury
acute lpb
Acute lower back pain < 4 wks
non-pharm (4)
remain active
apply heat
massage
acupuncture
chronic lpb
>12 wks
(Subacute 4-12)
non-pharm (7)
remain active apply heat acupuncture yoga Cognitive Behavioural Therapy Progressive Relaxation Intensive Interdisciplinary Rehab
Pharm therapy
what is described?
325–1000 mg Q4–6H PO
SR: 650 mg Q8H PO (maximum 4 g/day)
acetaminophen
Maximal onset of pain relief: within 24–
48 h
Try 2-4 wks to allow pt fully assess effectiveness
Guidelines no longer recommend aceta for acute or chronic low back pain
- Does not provide superior pain releif - May be ineffective - Do not exceed max dose
Pharm therapy
what is described?
200–400 mg Q6–8H PO; maximum dose
for self‐care 1200 mg/day
220–440 mg/day PO in 1 or 2 divided
doses; maximum dose for self‐care 440
mg/day
NSAIDs
• ibuprofen,
• naproxen sodium
none are superior
preferred over aceta
name 2 muscle relaxants
AE for both?
methocarbamol 1g qid
Orphenadrine 50‐100mg
Drowsiness, dry mouth, dizziness, fatigue, nausea,
constipation (caution for elders)
muscle relaxants
methocarbamol 1g qid
drug interaction: Additive CNS depression
Combo with OTC analgesics
evidence unclear
muscle relaxants
Orphenadrine 50‐100mg
can be given as single hs dose
evidence unclear
