Spinal Pain Introduction - Week 1

Question 1

List the key elements of a medical history for a person with a spinal condition

Answer 1

• Body chart
• Current history (duration, course onset, MOI)
• 24hr behaviour (aggravating/easing factors)
• Past history
• Special questions (ruling out serious pathology)
• Social history

Question 2

Classify a patient with spinal pain using the diagnostic triage

Answer 2

• Serious or specific pathologies: tumour, infection, inflammatory disease, cauda equina, <1% of all cases
• Spinal nerve/nerve root involvement: radicular pain and/or radiculopathy, <5% of all cases
• Non-specific spinal pain: many symptoms and presentations

Question 3

Explain the terms somatic pain, radicular pain and radiculopathy as well as their relationship to the diagnostic triage

Answer 3

Somatic Pain: pain that results from noxious stimulation of one of the musculoskeletal components of the body (stimulation of nerve endings in bone, ligament, joint or muscle)
Radicular pain: caused by irritation of spinal nerve/nerve root due to inflammation (compression or disc issue) shooting or band pain
Radiculopathy: blocked conduction in axons caused by disc herniation/foraminal stenosis

Question 4

Identify characteristics of patients likely to have serious spinal pathology

Answer 4

• Unwell
• Recent unexplained weight loss
• History of Ca, steriods, drug abuse, HIV
• Constant pain
• Non-mechanical pain
• Trauma
• S&S inflammatory disorders (e.g. morning stiffness)
• <20, >50 yo
• Family history of inflammatory disorders

Question 5

Discuss the relative sensitivity and specificity of red flags for identifying serious spinal conditions

Answer 5

Henschke et al 2008 showed that the best red flags that positively indicated serious pathologies were age >70yo, significant trauma, and prolonged use of corticosteroids - these were common indicators for vertebral fractures

Question 6

Distinguish features of mechanical vs. inflammatory back pain

Question 7

Identify and assess yellow flags indicative of poor prognosis

Question 8

Analyse history findings to identify likely impairments/mechanisms

Question 9

Use information from the history to plan an appropriate physical examination