Back Pain Flashcards
(38 cards)
What can cause back pain?
- Mechanical pain
- Fracture
- Malignancy
- Infection
- Inflammation
- Autoimmune conditions
What can cause mechanical back pain? (4 answers total)
- Lumbar strain/sprain of muscles
- Bulging/herniated intervertebral disc
- Spinal stenosis
- Facet joint disease (osteoarthritis)
What can aggravate mechanical back pain?
Certain movements and postures
What percentage of missed work days in the UK are attributed to back pain?
40%
Define Spondylosis
Stress fracture of the pars interarticularis
What are the features of spondylosis?
- Mild lumbar pain
- Common in sports people
- Limited cause of disability
Define Spondylolisthesis
‘Slipped disc’ - the intervertebral disc becomes slipped in-between the vertebra.
What are the features of spondylolisthesis?
- acute or insidious onset
- Nerve root symptoms
- Step deformity
- Pain on back extension
- Tender paraspinal musculature
What Cancers commonly metastasise to bone?
Kidney - Kinds Ovarian - Of Thyroid - Tumours Lung - Leaping Prostate - Promptly Testicular - To Myeloma - My Breast - Bone
What sort of back pain will be a red flag for malignancy?
Thoracic back pain
Back pain on waking
Back pain that wakes from sleep
What are the rarer forms of bone cancer?
- Chondrosarcoma
- Sarcoma
What 3 infections can commonly cause back pain?
- Discitis
- Osteomyelitis
- TB
What percentage of the UK population complain of back pain within their lifetime?
60-80%
What is the main cause of back dominant pain?
Being a walking mammal, causes pain in the back occasionally
What is the main cause of leg dominant back pain?
A disc problem is the main cause of this as it puts pressure on the nerve roots in the vertebral column. This is often improved on lying flat
What sort of back and leg pain improves on moment and worsens on sitting?
Neurogenic claudication
What is so important to encourage in patients with back pain?
MOVEMENT is key! Ensure the patient keeps moving with the back pain, provide analgesia.
List back pain RED FLAGS
- Altered bowel/bladder habit (Cauda Equina)
- Saddle paraesthesia (Cauda Equina)
- Change in sensation in the legs/pelvic area (Cauda Equina)
- Pyrexia (Sepsis?)
- IV drug user or immunocompromised patient with septic signs and back pain
- Fall induced back pain - osteoporosis?
- ANY Cancer red flags - weight loss, night sweats, loss of appetite
What are yellow flags in back pain patients?
Think of the patients’ attitudes towards their back pain, including their beliefs, attitudes and emotions. This includes the way the patient is supported by friends, family and their workplace.
What is the STarT back Keele screening tool?
A questionnaire to be completed by the patient, asking them questions about their back pain and how it has been affecting them in the last 2 weeks. This will help us to understand how the patient perceives their medical state.
What score from the STarT back tool would classify a patient as ‘low risk’?
3 or less
What score from the STarT back tool would classify a patient as ‘Medium risk’? (sub score Q5-9)
3 or below
What score from the STarT back tool would classify a patient as ‘High risk’? (sub score Q5-9)
4 or more
List the symptoms of Cauda Equina Syndrome (6 total from CKS)
- Bilateral sciatica
- Severe or progressive bilateral neurological deficit of the legs
- Difficulty initiating micturition or impaired sensation of urinary flow, with later retention an overflow
- Loss of sensation of rectal fullness and later faecal incontinence
- Saddle anaesthesia or paraesthesia
- Laxity of the anal sphincter
