Primary Care Management of Lower Back Pain Flashcards
What do patients present to their GP with?
Pain - localised or lumbar Referred pain - sciatica Stiffness Loss of sleep Loss of function - walking, lifting carrying - ability to work
What symptoms suggest other pathology
Urinary tract
Gastrointestinal
Respiratory
Systemic illness
What should be tested in the blood if you suspect something may be more sinister with the back pain
ESR
Viscosity
Calcium
Alkaline phosphatase
When do we MRI a patient with back pain
If there are red flags or considering surgery (non resolving sciatica, spinal stenosis)
What are some red flags for back pain
Age 50 Thoracic pain Previous carcinoma Immunocompromised Feeling unwell Weight loss Widespread neuro symptoms Structural spinal deformity
What are some yellow flags for back pain
Low mood High levels of pain / disability Obesity Job dissatisfaction Lot of lifting at work
how can we manage a patient with chronic lower back pain
Explanation and reassurance encourage to mobilise cultivate PMA Anagesia NSAIDs Muscle relaxants (diazepam) Physio Osteopathy Referral
What are some causes of back pain
Muscular strain Ligamentous disruption Facet arthropathy Disc arthropathy Disc degeneration Internal disc disruption Segmental instability Tumours Fractures Gynaecological Psychological
Early intervention is important for back pain. Why
To have a higher chance of returning to work
What is the typical presentation of spinal claudication
Age 50+ Higher incidence in males Historically manual workers Obesity is now a major factor Limited walking capacity Stoop/ sit / lean forward to relieve symptoms Heavy or tired legs
How can we make a diagnosis of spinal claudication rather than vascular
Relieved by flexing whereas vascular is relieved by standing
Uphill often not bad whereas vascular, uphill is bad
Cycling easy whereas in vascular, it is bad
Describe discogenic pain
Worse as the day goes on worse on flexion worse with activity deep seated central lower back pain segmental instability (pattern of pain typically a background ache with exacerbations and remissions superimposed)
What can severe disc degeneration be treated with
An anterior fusion
What is a typical presenting complaint from someone with facet arthropathy
Stiff in the morning Loosen up routine Restless Difficulty sitting, driving ,standing Worse with extension Better with activity Often radiates to buttocks and legs
What treatment an we use for facet joint arthropathy
Excision of facets and fusion
