Back Pain

Question 1

Causes of back pain (NHS website)

Answer 1

Pulled muscle/strain
Slipped disc
Sciatica
Ankylosing spondylitis

Question 2

Treatments

Answer 2

Painkillers (ibuprofen)
Physiotherapy
Manual therapy
CBT
Surgery

Question 3

What is somatotropic arrangement?

Answer 3

Different areas of the body correspond to different areas of the somatosensory cortex of the brain

Question 4

What is affective neuroscience?

Answer 4

Stimulation of different parts of the brain causes different effects

Question 5

What can stimulation of the cingulate gyrus cause?

Answer 5

Aversion

Question 6

What can stimulation of the insula cortex cause?

Answer 6

Vasoconstriction
Sweating
Increased pulse rate

Question 7

What can stimulation of the amygdala cause?

Answer 7

Fear

Question 8

What can stimulation of the reticular formation cause?

Answer 8

Arousal

Question 9

Path of action potential for fine touch?

Answer 9

Sensory neurone via dorsal column-> medulla oblongata (decussation) via medial leminiscus-> thalamus -> sensory cortex

Question 10

2 spinothalamic tracts?

Answer 10

Fast, sharp, a-delta fibres, often external pain and very precise (myelinated)

Slow, dull, C fibres, often internal pain

Question 11

Fast spinothalamic tract route?

Answer 11

Receptor -> dorsal horn, decussates in spinal cord -> thalamus -> sensory cortex

Also connected to S II region (affects vision) and insula region (so causes vasoconstriction, sweating and increased pulse rate)

Question 12

Slow spinothalamic route?

Answer 12

Receptor -> dorsal región (vía paleothalamic tract) -> decussates at spinal cord -> past reticular formation -> sensory + cingulate + amygdala
reticular - arousal
amygdala - fear
cingulate - aversion

Question 13

Look at different brain regions mapped out

Answer 13

!!

Question 14

Dorsal column sensations?

Answer 14

Fine touch, pressure, proprioception

Question 15

Anterolateral column sensations?

Answer 15

Pain, temperature, light touch

Question 16

Possible causes of medial posterior back pain?

Answer 16

1. Vertebrae
2. Spinal cord
3. Nerve roots
4. Lumbar muscles (e.g. erector spinae)
5. Aorta
6. Kidneys
7. Pancreas

Question 17

Science of referred pain?

Answer 17

Organs/viscera can synapse near skin dermatomes

Question 18

At what level does the spinal cord end as an adult?

Answer 18

L1

Question 19

How do spinal nerves get to the spinal cord if they are lower than L1?

Answer 19

Via the cauda equina

Question 20

Radiculation?

Answer 20

Often due to disc herniation compressing spinal nerve
Unilateral

Question 21

Cauda equina syndrome

Answer 21

L4/L5 and L5/S1 most common sites of nerve compression in CES
Disc herniation compressing cauda equina

Question 22

Red flag symptoms of cauda equina syndrome?

Answer 22

Bilateral sciatica
Severe or progressive bilateral neurological deficit of legs (e.g. major motor weakness with knee extension, ankle eversion, or foot dorsiflexion
Difficulty initiating micturition or impaired sensation of urinary flow
Loss of sensation of rectal fullness
Perianal, perineal or genital sensory loss (saddle anaesthesia or paraesthesia)
Laxity of anal sphincter
Erectile dysfunction

Question 23

Sympathetic nerves also known as?

Answer 23

Thoracolumbar (T1-L2)
cauda equina syndrome only affects below this level, so sympathetic activity will not be affected by the condition

Question 24

Parasympathetic nerves also known as?

Answer 24

Craniosacral
CES can affect these levels, so PNS functions (like micturition and sexual function) can be affected by the condition

Question 25

Sympathetic nervous system effect on bladder?

Answer 25

Relaxes detrusor muscle (so it can fill) Contracts internal urethral sphincter (so urine cannot leave)

Question 26

PNS effect on bladder?

Answer 26

Pelvic nerve from S2, 3 + 4 Contracts detrusor (so pushes out urine) Relaxes urethral sphincter (so allows urine to leave) *sensory info also lost so unaware when need to urinate*

Question 27

Voluntary control of micturition

Answer 27

Pudendal nerve (supplying external sphincter) can also be affected by CES

Question 28

Rare causes of CES?

Answer 28

Tumour Infection

Question 29

What is breach of duty?

Answer 29

the care provided by the doctor fell below a reasonable standard

Question 30

What is causation?

Answer 30

the breach has caused loss or damage

Question 31

Red flag symptoms legally

Answer 31

Pain that radiates below the knees bilaterally (on rare occasions this can be unilateral). Bilateral lower limb numbness or weakness. Numbness either side of the buttocks and saddle area. Bladder and/or bowel disturbance (including difficulty passing urine, poor stream, loss of sensation). Erectile dysfunction. Loss of anal tone or impaired sensation on per rectal (PR) examination.

Question 32

If no red flags, legally:

Answer 32

Make a record in the notes Give safety net advice