Therapists: Back Pain

Question 1

what symptoms require referral to emergency neurosurgery?

Answer 1

cauda equina syndrome
saddle numbness
urinary hesitancy, bowel changes

Question 2

what symptoms require urgent referral?

Answer 2

past/current cancer
weight loss
non-mechanical pain
severe night pain not improved by lying in bed
PMH of TB, HIV, IV drug use (spinal infection risk)
recent trauma, osteoporosis, long term steroid use
prolonged early morning joint stiffness
widespread neurological stiffness

Question 3

what symptoms indicate a nerve root pain rather than a simple backache?

Answer 3

unilateral leg pain
paraesthesia in same distribution
Leg > back pain
Abnormal neurology
Weakness, reflex changes, sensory changes, nerve stretch pain

Question 4

does nerve root pain require urgent referral?

Answer 4

no

50% better in 8 weeks

Question 5

what can a GP do for backpain?

Answer 5

advice (keep active)
medication (NSAIDs, opiates)
refer for physio, imaging or surgical review

Question 6

what can an ortho or neurosurgeon do for backpain?

Answer 6

surgery
watchful wait
refer for physio or imaging

Question 7

what can a rheumatologist do for backpain?

Answer 7

imaging
bloods
look for seronegative arthropathies

Question 8

via what 3 professions can a patient have manual therapy?

Answer 8

physiotherapy
osteopath
chiropractor

Question 9

osteopath vs chiropractor?

Answer 9

osteopath can manipulate, massage and give exercises

chiropractor can only manipulate

Question 10

what can a physio do?

Answer 10

advice
direction specific exercises
abdominal training
mobilisation/manipulation
pain management
referral for imaging, ortho or neurosurgeon

Question 11

what can occupational health do?

Answer 11

work based adaptions to role or workstation (desks etc)
change of job
medical retirement

Question 12

what can the pain clinic do?

Answer 12

explanation
medication management
exercise and/or physio
psychological therapy, CBT, mindfulness
interventional therapy, peri-radicular injection, facet joint injections

Question 13

what is done for nerve root pain?

Answer 13

advice
pain relief
refer for physio
refer for imaging if not getting better after 2 months and a 4 weeks course of physio or neurological signs are worsening
refer to ortho or neurosurgery if patient has evidence of a surgical target

Question 14

how is simple or mechanical low back pain managed?

Answer 14

advice, reassurance etc
offer pain relief
refer for physio if not improving after 6 weeks or struggling with daily tasks at home or work