primary care management of back pain Flashcards
What is the usual imaging in back pain
No imaging required
When would use use a lumbar spine x-ray
red flags
When would you do a lumbar spine MRI
If sciatica >4 weeks or spinal claudification. MRI is the gold standard
What does LOSS stand for
Loss of joint space
Osteophytes
Sclerosis
Subarticular cysts
What are the common cancers that go to the bone?
Breast
bronchus
prostate
What are the yellow flags for back pain?
Low mood high levels of pain/disbability belief that activity is harmful low educational level obesity problem with claim/compensation job dissatisfaction light duties not available at work lots of lifting at work
What is helpful in the management?
General- explanation, reassurance, encourage to mobilise,cultivate PMA
Drugs- analgesics, NSAID’s short term and muscle relaxants e.g. diazepam short term
Other- physiology, osteopathy and chiropractic and referral
Long term the patient is much better off if they have surgery T/F
F- there is no difference later on in life. If simply speeds up the natural process
Spinal claudification is most common in
age 50+
males ( 2 x as likely)
Historically manual workers, now obesity
What is there difference between spinal and vascular claudification?
Spinal
- relieved by flexing
- uphill often not bad
- cycling easy
Vascular
- relieved by standing
- uphill bad
- cycling bad
What is discogenic pain?
"Segmental instability" worse as day goes on worse inflexion worse with activity deep seated central lower back pain
What is facet arthrpathy?
stiff in the morning "loosen up routine" "restless" difficulty sitting, driving,standing worse with extension better with activity often radiates to buttocks and legs
