Lower Back Pain

Question 1

___ of adults in United States have had low back pain
___ only to headache as most common pain problems
___ cause of job related disability
___contributor to missed work days

Often due to ____

Answer 1

80%
Second
Leading
Major
Musculoskeletal problems

Question 2

Low back pain is common because of lumbar region
Why ? (4)

Answer 2

Bears most body weight
Is most flexible
Contains nerve roots
Has poor biomechinal structure

Question 3

Notes
Low back pain
Risk factors

Lack of muscule tone
Excess body weight
Pregnancy
Stress
Poor posture
Cigarette smoking
Prior compression fractures
Congenital spinal problems
Family history of back pain
Jobs that require heavy lifting

Question 4

Notes
Low back pain
Health promotion

Proper body mechanics
Back school
Physical therapy
Appropriate body weight
Proper sleep positioning
Firm mattress
Stop smoking

Question 5

The causes of musuloskletal low back pain is ? (5)

Answer 5

Acute lumbosacral strain
Instability of bony lumbosacral mechanism
Osteoarthritis of lumbar sacral vertebrae
Degenerative disc disease
Herniation of intervertabl disc

Question 6

Low back pain cause either be localized or diffused which means?
Or
Radicular or referred

Answer 6

Localized - certain area

Diffuse - larger area and comes from deep tissue

Radicular - irritation of nerve root
Referred - causefrom another location

Question 7

Acute low back pain
Can last up to how many weeks?
Caused by (2)?
Symptoms appear within how many hours from ___ on ___or ___

What are the 3 symptoms?

Answer 7

4 weeks or less
Trauma or undue stress
24 hours from pressure
Nerve or edema

Muscule ache/shooting/stabbing pain
Limited flexibility/ROM
Inability to stand up right

Question 8

There are very few diagnostic studies we can do however we can do two test
Define them

Answer 8

Straight leg raising
- positive for disc Herniation when radicular pain occurs

MRI/CT
- trauma or suspected systemic disease

Question 9

Notes
Subjective data
- past health history
( acute or chronic lumbosacral strain, osteoarthritis, defenerative disc disease )

• medications
  ( muscle relaxants, corticosteroids)
• surgery or other treatments
  ( previous back or epidural injections )

Question 10

Notes
Subjective data
Smoking
lack of exercise
Poor posture
Muscule spams
Activity intolerance

Constipation
Sleep being intreuppted

Pain in back, buttocks, legs
Numbness

Relationships

Occupational risk and impact on family

Question 11

What is 8 red flags anagram for low back pain?

Answer 11

Tuna fish

Question 12

What does tuna fish stand for? (8)

Answer 12

Trauma
Unexplained weight loss
Neurologic symptoms
Age > 50
Fever
Intravenous drug use
Steroid use
History of cancer

Question 13

Acute low back pain
Nursing assessment
Objective data

General is ?
Neurologic is (4) tests

Musculoskeletal (2 )

Answer 13

Guarded movement

Depressed Achilles tendon or patellar reflex
Positive straight leg raise test
Positive crossover straight leg test
Positive trendelenburg test

Tense tight paravertebral muscles
Decreased ROM in spine

Question 14

Acute low back pain
Acute care
Treat as outpatient if not severe
Using what two meds (2)?
___the area
__manipulation
What type of therapy?
What 2 compresses?

If severe use what two meds?

Answer 14

NSAIDS, muscle relaxants
Massages
Back manipulation
Acupuncture
Cold and hold

Corticosteroids and opioids

Question 15

What could help a patient recover at home.
A brief period of rest ( days? )
But be careful and avoid ^

Avoiding activities like ?

And usually resolves within?

Answer 15

1-2 days
Avoiding prolonged bed rest

Lifting, bending, twisting, prolonged sitting

2 weeks

Question 16

Notes
Acute care
Teach patients

• cause of their pain
• ways to prevent additional episode
• strengthening & stretching exercises

Question 17

Notes
Ambulatory care
Goal is to make an episode of acute low back pain an isolated incident

Manage risk factors
Exercise to strengthen muscles
Occupational counseling
Emotional support
Patient and caregiver education

Question 18

What are things a patient should do with low back pain? (8)

Answer 18

Sleep on side with knees bent
Sleep on back with knees lift
Placing foot on stool to prevent prolonged sitting
Posture
Exercise 15mins
Carry light items
Local heat /cold applications
Lumbar roll/pillow

Question 19

What should you NOT do for low back pain? (5)

Answer 19

Lead foward with bending knees
Lift anything above elbows
Stand in one position for long
Sleep on abdomen/back
Exercise without consulting

Question 20

Chronic low back pain last for how long and involved a what episode?
Often ?^

Answer 20

3 months and repeated incapacitating
Often progressive

Question 21

Notes
Chronic low back pain
Various causes

Degenerations conditions - arthritis
Osteoporosis
Weakness from scar tissue
Chronic strain - obesity, posture, preg
Congenial spine problem

Question 22

What is the most common condition of chronic low back pain?

Answer 22

Spinal stenosis

Question 23

What is spinal stenosis?

Answer 23

Narrowing of spinal canal that holds the spinal cord

Question 24

Spinal stenosis can be acquired (2)or inherited (2)

Answer 24

Acquired
- osteoarthritis
- tumors, Paget’s disease

Inherited
- congenital
- scoliosis

Question 25

Spinal stenosis
Pain in low back and radiates where ?
Pain increases with ?
Symptoms are (4)
Pain decreased with?

Answer 25

Buttock and leg

Walking/standing

Numbness, tingling, weakness, heaviness in legs

Bends forward or sits down

Question 26

What are the 3 drug therapy we can for chronic back pain?

Answer 26

Mild analgesics ( NSAIDS )
Antidepressant ( Duloxetine )
Gabapentin ( Neurontin )

Question 27

Notes
Chronic back pain
Nursing and interpersonal management

Weight reduction
Rest period
Local heat and cold
Physical therapy
Exercise
Complementary therapies
Back school

Question 28

What are 2 minimally invasive treatments for chronic back pain?

Or surgery

Answer 28

Epidural corticosteroid injections
Implanted devices to deliver analgesia