L12 - back pain

Question 1

function of the spine

Answer 1

• allows for a full range of movement
• protects spinal nerves
• acts as a shock absorber
• flexibility

Question 2

curves in normal health spine (descending)

Answer 2

• cervical lordosis
• thoracic kyphosis
• lumbar lordosis

Question 3

components of intervertebral discs

Answer 3

anulus fibrosis

nucleus pulposus

Question 4

anulus fibrosis

Answer 4

touch, fibrous

Question 5

nucleus pulposus

Answer 5

squidgy

Question 6

trapped nerve

Answer 6

nucleus pulposus herniates

Question 7

why does back become stiff with age

Answer 7

• discs lose water
• lose strength
• become thin
• tears due to repetitive loading
• weaker discs = slacker ligaments
• spine is less stable
• spine grows osteophytes
• increased load over facet joints

Question 8

how does back pain result in muscle weakness and wasting

Answer 8

people are afraid to move because it hurts

Question 9

key messages regarding a healthy back

Answer 9

keep flexible

keep strong

Question 10

determinants of back pain

Answer 10

• genetics
• environment
• body weight
• muscle strength
• mechanical loading

Question 11

risk factors for LBP at work

Answer 11

• Heavy physical jobs
• Lifting
• Driving to work
• Previous episodes of LBP
• Mental health
• Posture

Question 12

LBP classification

Answer 12

• simple backache
• nerve route involvement
• possible serious spinal pathology

Question 13

simple mechanical back pain history

Answer 13

• First episode often sudden onset while lifting/twisting/turning
• Recurrent episodes with decreasing inter-episode frequency
• Variable pain related to position/posture
• Better lying flat
• May radiate to buttock and leg
• Often worse at the end of the day and better with lying down/resting

Question 14

what % of people over 65 show wear and tear / degenerative changes to their spine

Answer 14

100

Question 15

examples of degenerative changes to spine with age

Answer 15

• facet arthritis
• disc narrowing
• osteophytes

Question 16

early management of LBP

Answer 16

• Simple analgesics
• Physiotherapy
• Rest for no longer than 1-3 days
• Psychosocial management
• Work absence only if unavoidable
• Early return to work, possibly graded

Question 17

when to consider secondary care for LBP

Answer 17

if >6 weeks

Question 18

drug treatment for LBP

Answer 18

• paracetamol
• NSAIDs
• opiods
• anti-depressants
• nerve modulators

Question 19

examples of opioids used for LBP

Answer 19

cocodamol
tramadol
morphine

Question 20

examples of anti-depressants used for nerve pain

Answer 20

amitriptyline, duloxetine

Question 21

examples of nerve modulators for LBP

Answer 21

gabapentin

pregabalin

Question 22

sciatica

Answer 22

slipped disc at point of sciatic nerve

Question 23

symptoms of sciatica

Answer 23

• pins and needles in leg
• numbness and weakness
• loss of ankle jerk
• foot drop

Question 24

rheumatology back pain diagnoses

Answer 24

• Degenerative disease
• Axial Spondyloarthritis
• Osteoporosis
• Osteomalacia
• Paget’s disease
• Infection
• Tumour

Question 25

red flag symptoms for back pain

Answer 25

- age at first onset - history of carcinoma - weight loss - constant pain >1 month - no response to treatment - pain worse at rest - history of IV drug abuse of HIV positivity - infections

Question 26

discitis

Answer 26

infection of spinal discs

Question 27

which cancers metastasis to bone

Answer 27

``` breast lung prostate thyroid kidney ```

Question 28

inflammatory back pain

Answer 28

- Insidious onset - Nocturnal pain with marked early morning stiffness - Better with exercise - Worse with rest - Family history - Buttock pain

Question 29

axial spondyloarthritis

Answer 29

inflammatory arthritis where main symptom is back pain - affects younger people - can result in spinal fusion

Question 30

osteoporosis risk factors

Answer 30

- Age - Female - Smoking - Steroids - Alcohol - Family history - Inflammatory conditions

Question 31

why is osteoporosis named the silent disease?

Answer 31

does not give you pain until you fracture

Question 32

which area is most commonly affected by osteoporosis

Answer 32

lumbar spine

Question 33

why are females more susceptible to osteoporosis

Answer 33

loss of oestrogen after the menopause

Question 34

How is osteoarthritis prevented

Answer 34

HRT

Question 35

Paget's disease

Answer 35

abnormally shaped, brittle bones | - raised alkaline phosphatase

Question 36

cauda equina syndrome symptoms

Answer 36

- difficulty with micturition (urinating) - loss of anal sphincter tone / facet incontinence - saddle anaesthesia - LBP / leg pain - degenerative arthritis

Question 37

consequences of not treating caudal equine syndrome

Answer 37

- permanent lower limb paralysis | - sexual, bladder and bowel dysfunction

Question 38

role of surgery in back pain

Answer 38

- Cauda equina syndrome - Spinal stenosis - (sciatica) - Tumour/infection - Instability

Question 39

neoplastic / Infection history

Answer 39

- Insidious onset, sometimes subacute - Slow deterioration - 24 hr pain - Weight loss - Associated symptoms - Sometimes fever (only sometimes though)