Primary Care Management of Back Pain Flashcards

1
Q

What do patients present to the GP with?

A

Pain = localised, lumbar, referred (e.g sciatica)
Stiffness
Loss of sleep and function (e.g walking, lifting, carrying)

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2
Q

What features will the patient’s history contain?

A

Pain = type, radiates/localised
Loss of function = subjective, try to find out how it impacts patient
Trauma (recent/past) or previous surgery
Symptoms suggesting other pathology = urinary tract, GI, respiratory, systemic illness

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3
Q

What are you looking for on examination of a patient?

A
Look = how the patient walks, deformity (eg scoliosis, kyphosis, scars)
Feel = spinal tenderness, paravertebral muscles
Move = flexion, extension, lateral flexion, SLR, tone, power, reflexes, sensation of legs if indicated
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4
Q

What investigations can be done?

A

Usually none, ESR/PV/calcium/alkaline phosphatase, rarely x-ray, MRI

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5
Q

When should an MRI be done?

A

Only if red flags present or if considering surgery (non-resolving sciatica, spinal stenosis)

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6
Q

What may imaging show?

A

Loss of joint space, osteophytes, sclerosis, subarticular cysts

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7
Q

What are some causes of back pain?

A

Mechanical/non-specific >90%
Tumour/metastases = 0.7%
Ankylosing spondylitis = 0.3%
Infection = 0.01%

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8
Q

What are some red flag symptoms?

A
Age <20 or >50
Thoracic pain
Feeling unwell
Widespread neurological symptoms
Previous carcinoma (breast, bronchus, prostate)
Immunocompromised (HIV, steroids)
Weight loss
Structural spinal deformity
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9
Q

What are some yellow flag symptoms?

A
Low mood
High levels of pain/disability
Belief that activity is harmful
Low education level
Obesity
Problem with claim/compensation
Job dissatisfaction
Light duties not available at work/heavy lifting at work
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10
Q

What do patients want from their GP?

A

Cure, analgesia, explanation, reassurance, restoration of function, referral, sick line

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11
Q

What are some non-pharmacological treatments?

A

Explanation, reassurance and encouraging positive mental attitudes
Physiotherapy
Osteopathy and chiropractic
Referral

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12
Q

What are some pharmacological treatments?

A

Analgesics = paracetamol, co-analgesics, opiates
NSAIDs (short term)
Muscle relaxants = diazepam (short term)

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