Spinal Masqueraders

Question 1

Characteristics Visceral pain + Referred Pain

Answer 1

• RP = Neuron convergence theory
• Visceral P= vague, diffuse & assoc. W auto responses (sweating, nausea)- can result in central sensitisation (hyperalgesia & increased M. tone)
• RP= localised & well defined, deep or superficial (cutaneous)

Question 2

Visceral Pain Referral sites

Answer 2

Pharynx- Ear
Heart- L. shoulder
Esophagus- substernal
Diaphragm- Shoulder
Pancrease- Mid back
Bladder/Urethra- Perineum/ Pelvis

Question 3

Suspecting pain is not due to mechanical cause

Answer 3

• pain seems out the ordinary
• Severe
• Refractory (non responsive to normal P relief/meds)
• Atypical in location or character
• may be due to Visceral disorders, infections, Tumors, metabolic Bone Disease (osteoporosis)

Question 4

Medical conditions masquerading as back pain

Answer 4

Emergency: Dissecting aortic aneurysm, ectopic preg., myocardial infarction
Urgent: Acute pancreatitis, Duodenal ulcer, Pyelonephritis, Visceral trauma
Potentially serious: gall stones, Endometriosis, Fibroids, Kidney stones, Pelvic Inflam D, pregnancy, prostatitis, UTI

Question 5

Detecting pathology causing Pain

Answer 5

• onset, cause, quality pain
• Abdominal P- suggests visceral
• Costovertebral angle P- Kidneys
• Colicky P- partial/complete obstruction hollow viscera)
• Severe/excruciating- increasing concern
• Worse at night/rest- malignant
• S+S illness or auto arousal (sweating, fever, hypertension)

Question 6

Examination clues

Answer 6

• Site of path palpation or active/passive movements recreating P, MSK will not
• neurological symptoms (weakness, loss bowel/bladder control, saddle paraesthesia)
• abdominal tenderness/ rebound tenderness
• Lack of recovery when expected

Question 7

Dissecting Aortic Aneurysm (emergency)

Answer 7

12% will present W back P
Tearing/ ripping severe P
Location P reflects site aneurysm
-Ascending A= Neck, -Aortic arch= Ant. chest 
-Descending Thoracic= Interscapular
-Diaph hiatus/abd= mid back/TL junction

Question 8

Myocardial Infarction (emergency)

Answer 8

Mid thoracic P & radiate to arm/axilla or jaw
P in substernal /L UEX
P unaffected by movement/change in position
Assoc. symp: Ant chest heaviness/crushing, Diaphoresis, Dyspnoea, nausea, sense of impending doom, weak pulse

Question 9

Ectopic Pregnancy (emergency)

Answer 9

Sexually active females must be considered if suffering LBP & Abd P.
Triad symp- Missed periods, Vaginal bleeding, abdom/LBP (lower pelvic or L1/2 dermatomes intermittent/deep)
Abdom exam = cramp P.
If tubal rupture then sudden sharp P. & signs hypovolemia

Question 10

Urgent conditions

• Trauma
• Acute Pancreatitis
• Duodenal Ulcer

Answer 10

Trauma: Pts often present with Hx trauma. Be sure to inc. retroperitoneal organs/duodenum may be injured & cause RP LB. occur with flex-distract inj. MVA.
Blunt trauma leads to pancreatitis or retroperitoneal hematoma.