Lower Back Pain, Red Flags and Emergencies

Question 1

What are some treatments for back pain?

Answer 1

Most are self-limiting = don’t image early, education, avoid bedrest, keep working, symptomatic relief, reassurance, combined physical and psychological programmes

Question 2

What is used to decide who needs referral for back pain in Scotland?

Answer 2

National back pain pathway

Question 3

What are the red flags for back pain?

Answer 3

Age < 20 or > 55 for first presentation of back pain
Non-mechanical, constant pain
History of cancer (breast, renal, lung)/steroid use
General malaise, fever, unexplained weight loss
Structural deformity
Saddle anaesthesia/paraesthesia +/- loss of bowel/bladder control
Severe pain > 6 weeks

Question 4

What are some emergencies for back pain?

Answer 4

Cauda equina syndrome
Spinal infection
Fractures with deterioration in function/symptoms

Question 5

What are some features of cauda equina syndrome?

Answer 5

Various urinary upsets, painless retention with overflow, most are atypical, weak evidence-symptom duration

Question 6

What are some examples of spinal infections?

Answer 6

Spondylodiscitis, vertebral osteomyelitis, epidural abscess

Question 7

What organisms cause spinal infections?

Answer 7

Staph, aureus and Staph. epidermidis

Granulomatous, tuberculosis and brucellosis (from goats) in developing world

Question 8

What may occur if spinal infections are left untreated?

Answer 8

Progressive collapse, psoas collections, neurological compromise

Question 9

What groups should you be cautious of in spinal infections?

Answer 9

Age between 59-69, IVDA, diabetes, immunocompromised

Question 10

What are some conditions that mimic back pain emergencies?

Answer 10

AAA, retroperitoneal tumours (e.g pancreas, renal)