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Flashcards in Low Back Pain Deck (22)
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1

What percentage of acute low back pain patients recover in 6 weeks?

90%

2

What percentage of people are fully recovered from an episode of acute low back pain after 3 months?

21%

3

Describe the difference in effect on the patient of pain of sudden onset vs. pain of gradual onset.

  • Pain of sudden onset = greater disability in the short term. 
  • Pain of gradual onset = greater correlation with psychological symptoms.

4

List 10 sources of spinal pain.

  1. Intervertebral disc and endplates
  2. Ligaments and capsule
  3. Zygapophyseal joints
  4. Bone
  5. Periosteum, fascia, muscle, tendons and aponeurosis
  6. Arteries and arterioles
  7. Epidural and paravertebral veins
  8. Dura
  9. Nerve root sleeve
  10. Nerve root and associated nerves

5

Explain what the surgical seive is.

Vascular

Accident & trauma

Neoplastic / neurological 

Inflammatory 

Septic

Haematological / hereditary

Endocrinological

Degenerative

6

What are the muskuloskeletal red flags of back pain?

  • Cauda equina syndrome
  • Infection / sepsis
  • Neoplasm (benign or malignant)
  • Trauma

7

What is the clinical presentation of cauda equina syndrome?

  • Difficulty with micturition
  • Loss of anal sphincter tone or faecal incontinence
  • Saddle anaesthesia about the anus, perineum or genitals 
  • Widespread (>1 nerve root) or progressive motor weakness in the legs or gait disturbance

8

What are the indicators of possible serious pathology associated with low back pain?

  • Age of onset <20 or >55 years
  • RTC
  • Thoracic pain 
  • Systemic steroids
  • Systemically unwell
  • Persisting severe restriction of lumbar flexion 
  • Structural deformity
  • Voilent trauma
  • Constant, progressive, non-mechanical pain 
  • PMH - carcinoma
  • Drug abuse or PMH of HIV
  • Unexplained weight loss
  • Widespread neurology
  • Widespread deformity

9

What percentage of low back pain is simple mechanical backache?

85-95%

10

What percentage of low back pain is nerve root associated?

5%

11

What percentage of low back pain is associated with possible serious pathology?

1-2%

12

What are the key questions which should be asked of a patient who presents with chronic low back pain?

  • Have you had tie off work with your back pain?
  • What do you think is causing your back pain?
  • What do you think will help you? (Active or passive treatments)
  • How are your employers, family and fellow employees reacting to your back pain?
  • How are you coping with your back? (Active or passive)
  • Do you think you will return to your present job? When?

13

What are the characteristics of radicular (nerve root) pain?

  • Unilateral leg pain leading to back pain
  • Pain generally radiating to foot or toes
  • Numbness and paraesthesia in the same distribution
  • Nerve irritation signs
    • Reduced straight leg raise which reproduced leg pain
  • Motor, sensory or reflex change
    • Limited to 1 nerve root
  • Prognosis is reasonable
    • 50% recover from acute attack within 6 weeks

14

Where would S1 root pain manifest?

15

Where would L5 root pain manifest?

16

Where would L4 root pain manifest?

17

Where would L3 root pain manifest?

18

What are the common features of spinal stenosis?

  • Typically progresses slowly.
  • Increased back and leg pain with walking (neurogenic claudication).
  • Relieved with flexion postures.
  • Pain on extension.
  • Muscle strength and sensation can be intact.
  • Decreased or absent ankle jerk reflex bilaterally.

 

  • In most cases the symptoms remain unchanged or with little variation over the years (60-70%).
  • There are also a few people who report that their condition improves with time. These people are able to walk further (15-20%).
  • Around 15-20% of peollple find their condition gets worse. Over time they find that the distance they can walk gets less and less. 

19

Describe the characteristics of 'mechanical, simple, non-specific, persistent' low back pain?

  • Age of onset generally 20-55
  • Lumbosacral region, buttocks and thighs 
  • Pain 'mechanical' in nature
    • Varies with physical activity
    • Varies with time
  • Patient is generally well
  • Prognosis is good
    • ~90% recover from acute attack within 6 weeks

20

Describe the characteristics of nociceptive low back pain.

  • Usually intermittent and sharp with movement/mechanical provocation: may be a more constant dull ache or throb at rest. 
  • Pain localised to the area or injury/dysfunction with/without some somatic referral.
  • Clear proportionate mechanical / anatomic nature to aggravating and easing factors. 
  • Absence of:
    • Pain variously described as burning, shooting, sharp or electric shock-like. 
    • Pain in association with other dyaesthesia.
    • Night pain / disturbed sleep
    • Antalgic (pain relieving) postures / movement patterns. 

21

Describe the characteristics of peripheral neuropathic low back pain.

  • History of nerve injury, pathology or mechanical compromise.
  • Pain referred in a dermatomal or cutaneous distribution.
  • Pain/symptom provocation with mechanical/movement tests that move/load.compress neural tissue.

22

Describe the characteristics of central (sensitisation) low back pain.

  • Pain disproportionate to the nature and extent of injury or pathology.
  • Disproportionate non-mechanical unpredictable pattern of pain.
  • Provocation in response to multiple/non-specific aggravating/easing factors.
  • Strong association with maladaptive psychosocial factors e.g. negative emotions, poor self-efficacy maladaptive beliefs and pain-behaviours, altered family/work/social life, medical conflict.
  • Diffuse/non-anatomicareas of pain/tenderness on palpation.