Back pain + analgesics

Question 1

Kyphosis; Most common cause in adults? Treatment for osteoporotic kyphosis?

Answer 1

Osteoporosis → compression fractures (anterior vertebrae)

Tx= Kyphoplasty (balloon + cement; 80-90% pain relief

Question 2

Scheuermann’s Disease; features + Tx

Answer 2

Key feature? Epiphyseal growth plate dysfunction → wedged vertebrae + exaggerated kyphosis

Treatment for curves >65°?
Surgery (bracing if <65°).

Question 3

Lordosis causes + Sx

Answer 3

Anterior pelvic tilt (pregnancy, obesity, weak trunk/hip flexors)

Sx= Backache, sciatica (weight shifts to posterior elements)

Question 4

Scoliosis key features + Tx

Answer 4

Lateral curvature + rotation; 3% prevalence (girls at puberty).

Treatment for 20-40° curves?
Bracing; surgery if >50°

Question 5

Herniated Disc; most common sites

Answer 5

L4/5 or L5/S1

Question 6

Cauda equina syndrome signs?

Answer 6

Saddle anesthesia, bowel/bladder dysfunction, sciatica, bilateral lower limb weakness/numbness

Question 7

Ankylosing Spondylitis (AS); hallmark findings + Gut link?

Answer 7

Bamboo spine, sacroiliitis, HLA-B27+ (95%)

Gut link? HLA-B27 → leaky gut → inflammation

Question 8

Osteoarthritis (OA) of Spine key changes

Answer 8

Osteophytes, disc height loss, spinal stenosis

Question 9

Rheumatoid Arthritis (RA) in Spine; most common issue?

Answer 9

Atlantoaxial subluxation (40% of RA patients) ; misalignment of the 1st and 2nd cervical vertebrae

Question 10

Diffuse Idiopathic Skeletal Hyperostosis (DISH) key feature?

Answer 10

Ossification of anterior longitudinal ligament (no SI joint involvement)

Question 11

Vertebroplasty vs. Kyphoplasty

Answer 11

Kyphoplasty uses balloon first (less cement leakage, better deformity correction

Question 12

Psoas Syndrome findings

Answer 12

Tight psoas → increased lordosis, weak abs, tight hamstrings/glutes

Question 13

Flat Back Syndrome

Answer 13

Posterior pelvic tilt (tight abs/glutes, forward head posture

Question 14

Key mediators in inflammatory pain?

Answer 14

K⁺, H⁺, bradykinin, histamine, 5HT, prostaglandins

Question 15

Neuropathic pain mechanism?

Answer 15

Nerve damage → ion channel changes, ectopic discharges, ephaptic conduction.

Question 16

Duration threshold for chronic pain?

Answer 16

> 12 weeks

Question 17

Features of chronic pain?

Answer 17

Central sensitization, poor treatment response, psychological component

Question 18

Name 3 pain scales

Answer 18

VAS, BPI, McGill Questionnaire

Question 19

WHO Analgesic Ladder; Step 2 drugs?

Answer 19

Weak opioids (codeine, tramadol)

Question 20

Paracetamol’s major toxicity?

Answer 20

Liver damage (OD)

Question 21

Tramadol MOA

Answer 21

Weak μ-opioid agonist + monoaminergic (NE/5HT) action

Question 22

Morphine’s main SEs?

Answer 22

Constipation, nausea, pruritus, drowsiness

Question 23

First-line drugs for neuropathic pain?

Answer 23

Gabapentin, pregabalin, TCAs (e.g., amitriptyline)

Question 24

What is the endogenous cannabinoid Anandamide?

Answer 24

Anandamide (AEA)= Anandamide is a CB1 agonist that interacts with vanilloid receptors to transduce and regulate nociceptive signals (including pain and itch) to the peripheral nervous system

Question 25

Jo Cameron’s rare mutation?

Answer 25

a woman living in Scotland, can feel virtually no pain due to a mutation in FAAH gene → anandamide excess → no pain/fear

Question 26

What therapy is offered to chronic pain individuals

Answer 26

Acceptance and Commitment Therapy for Chronic Pain (ACT)

Question 27

Lidocaine MOA

Answer 27

Lidocaine blocks voltage-gated sodium channels (Nav) in neuronal and cardiac tissue, preventing the initiation and propagation of action potentials. In neurons: Inhibits sodium influx → blocks depolarization Result: Loss of sensation (anesthesia) in a local area