Back pain Flashcards

1
Q

Classic presentation of non-specific back pain

A
  • Lumbosacral area
  • Varies with posture and time
  • Worsened by movement
  • Typical onset after twisting/lifting with something heavy or vibration tool use
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2
Q

Red flags for back pain

A
  • Thoracic location
  • Severe localised pain relieved by lying down
  • Wakes from sleep
  • Saddle anaesthesia
  • Lower limb neurological signs - weakness/parasthesia
  • Bowel/bladder disturbance
  • Constitutional symptoms - weight loss/night sweats
  • Age onset <20 or >55
  • Steroids/IV drug use
  • Stiffness in morning >30 mins
  • Pain improves with exercise
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3
Q

Examination for non-specific back pain

A
  • No red flags
  • Exacerbated by movement
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4
Q

Investigations for non-specific back pain

A

None unless you suspect it isn’t just non-specific back pain

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5
Q

When would you investigate back pain?

A
  • Red flags - MRI if soft tissues/osteomyelitis
  • If suspect osteoporotic # - spinal x-ray
  • Urine dip if suspecting pyelonephritis
  • ESR/CRP if suspect rheumatological cause
  • WCC/CRP if suspect discitis/osteomyelitis
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6
Q

Management of non-specific back pain

A
  • STarT back tool - assess risk of back pain disability
  • Advice - sources of info eg backcare.co.uk, chartered society of physiotherapy patient info
  • Encourage activity
  • OTC NSAID 1st line (+PPI)
  • If contraindicated or not working - weak opioid eg codeine
  • If muscle spasms causing - short course (days) of Diazepam
  • Physio, group exercises and CBT if more chronic
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7
Q

When is radiofrequency denervation considered?

A
  • Failed to respond to non-surgical treatment
  • Main source pain related to branches of medial branch nerve (facet joint pain)
  • Pain rated as 5 or more on visual analogue scale or equivalent

Denervate the nerves which carry pain signals from the joints and have no other function really

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8
Q

Management dependent on STarT score

A
  • Low risk patients: can be managed with reassurance and encouragement to remain active, early managed return to work and simple analgesia
  • Medium risk patients: should be managed as per low risk in addition to offering a referral to physiotherapy
  • High risk patients: should be referred to psychologically informed physiotherapy.
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9
Q

How long for non-specific back pain to resolve?

A
  • 4-6 weeks usually
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10
Q
A
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