3. Intro To Low Back Pain

Question 1

The natural history of LBP is that greater than 90% of patients will have significant improvement in symptoms in what timeline? What percentage will have an additional episode of LBP within a year?

Answer 1

8 weeks

65%

Question 2

What percentage of low back pain patients will go on to have disabling chronic low back pain?

Answer 2

10%

Question 3

What percentage of LBP patients will continue to experience moderate or intense pain at 1 year?

Answer 3

33%

Question 4

What percentage of LBP patients will report important functional limitations long term?

Answer 4

20%

Question 5

When is LBP considered chronic?

Answer 5

Greater than 3 months

Question 6

When is LBP considered acute

Answer 6

Less than 3 months

Question 7

What are 5 common ways to injure the low back

Answer 7

• repetitive microtauma
• sustained postural load
• traumatic events
• unguarded movement
• normal activity with unstable spine

Question 8

What are the 6 injuries that cause non-specific mechanical back pain?

Answer 8

• disc derangement
• strain
• facet syndrome
• joint dysfunction
• myofascial pain syndrome
• sprain

Question 9

Non-specific mechanical back pain should be presented to patients with a specific message. What is this message?

Answer 9

• pain does not = degree of tissue damage
• activity is important even when still experiencing pain
• improvement in ADLs is important, not just pain relief
• prognosis is favorable for pain and return to function

Question 10

What are the CAC guideline recommendations for acute and subacute low back pain?

Answer 10

• non-pharmacologic treatment such as heat, massage, spinal manipulation
• NSAID’s or skeletal muscle relaxants

Question 11

What are the CAC guideline initial recommendations for chronic low back pain?

Answer 11

• initially should select non-pharmacologic treatment such as spinal manipulation with exercise

Question 12

What are the CAC guideline recommendations for acute and subacute low back pain if they have had inadequate response to non-pharmacologic therapy?

Answer 12

• first line: NSAIDs
• second line: low dose opioid (tramadol) or anti-anxiety (duloxetine, cymbalta)
• only if they fail the first and second line should stronger opioids be considered

Question 13

What are the outcome markers used to measure pain?

Answer 13

• OPS - oral pain scale
• VAS - visual analogue
• FPS - faces pain scale
• pain med consumption
• frequency and duration of pain

Question 14

What are outcome markers used for affect on work and ADL’s

Answer 14

• PSFS (patient specific functional scale)
• oswestry
• Roland Morris
• length of time sitting, standing, etc.