treatment guidelines LBP Flashcards
pharmacological mgmt
acute
chronic
acute msk pain
1st like paracetemol (not for LBP)
NSAIDS
second line NSAID + nonbenzodiazepene muscle relaxants
thirds line - opioid - codeine, tramadol, zydol (for short period)
take consistently
chronic
local anaesthetics - lidocaine patches
spinal epidural injection - targeted analgesic + steroid
anti-depressant eg. amitriptyline
blocks reuptake of NA/ serotonin in midbrain
6/52-3/12 for effect
opioids not effective!
pharmacological mgmt
neuropathic nociplastic pain
anti-convulsants gabapentin = Lyrica anti-depressants amitriptyline corticosteroids opioids strong - morphine oxycodone pethidine NMDA receptor antagonist. ketamine infusion
keele start back questionnaire
primary back care screening tool
My back pain has spread down my leg(s) at some time in the last 2 weeks
I have had pain in the shoulder or neck at some time in the last 2 weeks
I have only walked short distances because of my back pain
In the last 2 weeks, I have dressed more slowly than usual because of back pain
It’s not really safe for a person with a condition like mine to be physically active
Worrying thoughts have been going through my mind a lot of the time
I feel that my back pain is terrible and it’s never going to get any better
In general I have not enjoyed all the things I used to enjoy
Overall, how bothersome has your back pain been in the last 2 weeks?
scoring
<3 low risk
4/< -subscore <3 medium risk physical obstacles to recovery
4/< high risk - psychological obstacles to recovery
keel back starter questionnaire
low risk
medium risk
high risk
medication review
encourage activity and self management
oral and written information
build on low risk
restore function
minimise disability
general functional activities
builds on low and medium reduce pain reduce disability restore function 6 physio appointments over 3 months physical and cognitive behavioural approach identify obstacles to rehab
NICE guidelines LBP and/- sciatica
consider alternatives
cancer infection trauma cauda equina
–> referral
assess likely recovery outcomes
consider using risk stratification START back assessment tool
provide self management information
management acute sciatica
neuropathic pain medication
exercise
pharm Rx
manual therapy treatment
psychological therapies
DO NOT OFFER
acupuncture and electrotherapy
traction orthotics belts and corsets
american college of physicians’ clinical practice guideline
non-invasive for acute subacute and chronic LBP
1)acute or sub
- non pharm - heat massage acupuncture spinal man
pharm - NSAIDS / muscle relax
2) chronic
- non pharm with exercise
MDT rehab
acupuncture
tai chi
motor control
progressive relax
LLT
operation therapy
CBT
spinal manipulation
3) inadequate response to non pharm NSAIDs tramadol or duloxetine only opioids if before Rx hasn't worked and risks have been discussed with patients
lancet back pain series
education and self care
acute low back pain
remain active education
superficial heat
persistant LBP
remain active education
insufficient evidence for superficial heat
exercise therapy + CBT for persistent LBP
spinal manipulation and acupuncture
= second line / adjunctive treatment option for acute and persistent LBP
lancet back pain series
pharm mgmt
pharm therapy
acute + chronic - paracetamol not recommended
NSAIDS - 2nd line for acute and chronic
skeletal muscle relaxant - insufficient
opioids - limited use in selected patients with acute LBP
interventional therapies - not recommended
lancet back pain series
surgery
acute X
persistent
2nd line or adjunctive treatment
for diseconomy herniated dic with radiculopathy
role uncertain for spinal fusion
MDT chronic pain programmes
MDT - physio pain consultant
psychologist
nurse OT ST SW
day programmes 3-6/52
physio
education exercise
CV fitness
min. man therapy
AIMS: increase functional capacity for norm age + sex decrease impact of pain on pts life teach coping skills for flare ups assist its in attaining own goals
