Back Pain

Question 1

What are some potential causes of back pain

Answer 1

Viscerogenic - due to organs
Spondylogenic – joints and muscles of the spine 
Discogenic – spinal discs 
Neurogenic – nerve roots 
Pyschogenic

Question 2

Describe referred back pain

Answer 2

Tends to be dull
Affects buttock and thigh
Rarely below knee
Ill defined sensory symptoms

Question 3

Describe nerve root back pain

Answer 3

Distribution will be dermatomal
Sharp, shooting pain
Invariably below the knee to foot/ankle
Anatomical sensory/motor symptoms

Question 4

How can back problems affect the bowel/urinary tract

Answer 4

Problems with the nerves in the back, particularly the cauda equina
Leads to incontinence and a loss of control/awareness
May get perineal or saddle anaesthesia

Question 5

List some possible spinal pathologies

Answer 5

Fracture - common in osteoporosis
Tumours - usually metastases but can be myeloma
Infection
Inflammatory - e.g. ankylosing spondylitis

Question 6

Which cancers commonly metastasise to the bones

Answer 6

Breast 
Lungs 
Prostate 
Thyroid 
Kidneys

Question 7

Which other features suggest the back pain is caused by cancer

Answer 7

Weight loss 
Anaemia 
Anorexia 
Night pain 
Constant pain 
Other symptoms linked to primary location

Question 8

Which other features suggest the back pain is caused by infection

Answer 8

Fever
Temperature
History of foreign travel

Question 9

What are some nerve root problems that can cause back pain

Answer 9

Disc prolapse
Large vertebral canal - pain from stretched annulus/posterior long ligament
Small vertebral canal - root compression

Question 10

Describe the meaning of disc prolapse

Answer 10

Disc protrudes out but is contained by ligament

Question 11

Describe the meaning of disc extrusion

Answer 11

Disc pushes out past the ligament

Question 12

Describe the meaning of disc sequestration

Answer 12

Nucleus pulposis squirts out of the disc itself

Question 13

How do you diagnose mechanical back pain

Answer 13

Diagnosis of exclusion

Must check there are no nerve root problems and no underlying pathological processes

Question 14

Which joints are common causes of mechanical back pain

Answer 14

Facet joints - common to get arthritic changes and malalignment
Sacroiliac - common source of referred back pain

Question 15

What is the most common type of back pain

Answer 15

Mechanical

Question 16

What is the most common cause of loss of lumbar lordosis

Answer 16

Spasm

Question 17

How do you test for nerve irritation/weakness in L1/2

Answer 17

Hip flexion

Question 18

How do you test for nerve irritation/weakness in L3/4

Answer 18

Knee extension

Question 19

How do you test for nerve irritation/weakness in L5

Answer 19

foot dorsiflexion

Question 20

How do you test for nerve irritation/weakness in S1/2

Answer 20

Ankle plantar flexion

Question 21

Which test is used to check for sciatica

Answer 21

Straight leg raise

If sciatica is cause this will trigger the pain

Question 22

What is sciatica

Answer 22

Buttock and/or leg pain with a specific dermatomal distribution accompanied by neurological disturbance

Question 23

Prolapsed discs are always the cause of back pain - true or false

Answer 23

False
May be completely asymptomatic
This is why scans aren’t always diagnostic as disc problems can be picked up incidentally

Question 24

Describe the common presentation of a disc prolapse

Answer 24

Episodic back pain
Onset of leg pain +/- neurology
Leg pain becomes dominant

Question 25

How do you treat disc prolapse

Answer 25

Treat pain first
70% settle in 3 months whilst 90% will have settled in 18-24 months
Surgery only used in severe cases or if cauda equina affected - very high risk op

Question 26

What are some psychosocial yellow flags that may be seen in back pain

Answer 26

Belief  that  back  pain  is  harmful  or potentially  seriously  disabling
Fear/ avoidance  behaviour
Low  mood / withdrawal
Passive  rather  than  active 
Job dissatisfaction 
Problem with claim/compensation 
Obesity 
Low education

Question 27

Psychological factors and stress can lead to back pain - true or false

Answer 27

True

Question 28

What are the most common presentations of back problems

Answer 28

Pain 
Referred pain - down legs 
Stiffness 
Loss of sleep 
Loss of function - e.g. struggling to walk, lift or carry things

Question 29

How would compression of the femoral nerve present

Answer 29

Pain will refer down the front of the leg

Less common than sciatica

Question 30

What urinary tract pathologies can cause back pain

Answer 30

Kidney stones

Renal colic

Question 31

What GI tract pathologies can cause back pain

Answer 31

Pancreatitis - usually get at front too

Gall bladder?

Question 32

What respiratory tract pathologies can cause back pain

Answer 32

Rarely pneumonia in lower lobes can lead to back pain

Question 33

What systemic illnesses can cause back pain

Answer 33

MANY

Viral infection such as flu commonly cause aches anf pains

Question 34

What investigations are done for back pain

Answer 34

Usually nothing
Blood tests if suspect inflammatory cause
Calcium & Alk Phos - can indicate bone damage
MRI -gold standard as shows soft tissue which is the most common cause of back pain

Question 35

What are some red flags of back pain

Answer 35

Age under 20 or over 55
Thoracic pain 
Previous cancer 
Immunocompromised
Feeling unwell or presence of other illness
Bladder or bowel dysfunction
Weight loss and fever
Widespread and progressive neurological symptoms 
Disturbed gait, saddle anaesthesia
Structural deformity

Question 36

List some common managements of back pain

Answer 36

Explain and reassure 
Encourage them to keep moving 
Analgesia 
NSAID -short term 
Muscle relaxants - e.g. diazepam 
Physio 
Osteopathy or chiropractic 
Referral if very severe

Question 37

What are the normal curves of the spine

Answer 37

cervical lordosis
thoracic kyphosis
lumbar lordosis