Primary Care Management of Low Back Pain

Question 1

investigations for back pain

Answer 1

none
esr/viscosity/calcium/alp
x ray sometimes
mri

Question 2

investigation for someone with sciatica plus lower back pain for a month

Answer 2

MRI lumbar spine

Question 3

investigation for someone with lower back pain and known osteoporosis

Answer 3

lumbar spine x ray

Question 4

investigation for lower back pain only

Answer 4

none

Question 5

what 2 requirements need to be met before you do an mri

Answer 5

red flags

if considering surgery

Question 6

short term treatments for back pain?

Answer 6

NSAIDs

muscle relaxants eg diazepam

Question 7

causes of back pain?

Answer 7

strain on muscles/ligaments
facet joint arthritis
disc degeneration
internal disc disruption
tumours
fractures
gynae
psych

Question 8

who tends to get spinal claudication most commonly?

Answer 8

50+ males who are either obese or labour workers

Question 9

clinical presentation of spinal claudication?

Answer 9

heavy/tired legs cause limited walking capacity; patient sits/leans forward to relieve symptoms

Question 10

how does spinal claudication differ from vascular

Answer 10

relieved by flexing body rather than standing, walking uphill is easier than downhill, can cycle

Question 11

clinical presentation of discogenic pain?

Answer 11

pain that is worse on flexion, activity and at the end of the day in the central lower back

Question 12

clinical presentation of facet arthropathy?

Answer 12

stiff in morning, difficulty sitting and standing, better with activity, radiates to bum and legs

Question 13

is flexion or extension worse in facet arthropathy?

Answer 13

extension

Question 14

which out of facet arthropathy and spinal claudication is better with activity

Answer 14

facet arthropathy