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Flashcards in Acute Low Back Pain Deck (17):
1

What are some red flag symptoms of low back pain?

- unrelenting pain at night/rest
- neuromotor deficit
- duration greater than 6 weeks (most benign back pain resolves in 2 weeks)
- loss of bowel/bladder control
- age greater than 70
- unexplained fever
- trauma
- alcohol abuse/IV drug use
- hx of cancer

2

Increasing neurologic defiicits, leg weakness, bowel and/or urinary incontinence, anesthesia/paresthesia in saddle distribution, bilateral sciatica, pain elicited by straight leg test, reduction in anal sphincter tone, decreased ankle reflexes bilaterally

cauda equina syndrome

3

how to manage cauda equina syndrome

immediate lumbosacral MRI, corticosteroids for pain/inflammation, immediate surgical decompression of cauda equina to prevent further neurological damage

4

Fevers, point tenderness over vertebrae

infectious procses (osteo, epidural of paraspinous abscess,)

check CBC and ESR

5

unexplained weight loss, worsening pain at night, failure to improve 1 month after conservative therapy

think cancer

6

What is sciatica and what is it a classic sign of?

sharp burning back pain that radiates down the back and side of the leg and distal to knee, improves lying down and increases with valsalva, coughing, sneezing...classic sign of herniated disc

7

How to test for sciatica

straight leg raise test and contralateral leg raise test along with sensory/reflex testing

8

conservative treatment for sciatica

NSAIDS, acetominophen, muscle relaxants (i.e. cyclobenzaprine), opoids in extreme cases

9

Congenital or acquired condition of spinal canal narrowing with or without concomitant facet hypertrophy that exerts presssure on spinal cord and nerve roots

spinal stenosis

10

What are the most common acquired causes of lumbar spinal stenosis

degenerative arthritis and spondylolisthesis

11

Presentation of spinal stenosis

lower back and leg pain, leg weakness, pseudoclaudication that occurs after walking various distances (although vessels are not compromised).

Pain relieved by sitting, performing lumbar flexion, squatting, or lying down

12

How to treat spinal stenosis

NSAIDS, muscle relaxants, PT, epidural corticosteroid injections

13

Risk factors for vertebral compression fractures

older age, chronic corticosteroid use, osteoporosis

14

What pain distribution to vertebral fractures usually follow?

contiguous nerve and radiates bilaterally to anterior abdomen and pelvis '"girdle of pain"

15

T/F: psychosocial factors are predictors of slow recovery and increase risk of developing chronic low back pain

TRUE. evaluate for these

16

Treatment for acute mechanical back pain (

NSAIDs, acetaminophen, muscle relaxants, heat, early mobility

17

T/F: Bed rest has been shown to improve pain and shorten recovery times

false!!!! THIS HAS BEEN SHOW TO DO THE OPPOSITE. MOVE AROUND HOMIE!