Lumbar Spine Flashcards
(14 cards)
Non-specific lower back pain
Very common
Affect all age groups
Lower back pain - between 12th rib and gluteal fold
Somatic referred pain - refers to one or both lower limbs; affecting muscles, joints or ligaments
Unable to identify a specific nociceptive cause
Around 90% of musculoskeletal causes of lower back pain
Non-specific lower back pain: Lower back pain trajectory
Severe and disabling, particularly initially
New episodes of non-specific lower back pain improve within 6 weeks and at 1 year pain levels are low
2/3 patients still report pain at 3 and 12 months
Recurrence is common - 33%
Lower back pain is increasingly recognised as a long-lasting condition
Non-specific lower back pain: persistent, severe and disabling lower back pain
Small proportion of people - 5-24%
Increased risk if - high pain intensity at onset, psychological distress, pain at multiple body sites/ joints
Factors in its development - central pain-modulating mechanisms, pain cognitions, genetics
Disproportionately affects those with adverse social determinants of health e.g. low social economic
Non-specific lower back pain: lower back pain is a complex condition
Multiple factors - psychological, social, biophysical, comorbidities, genetics, central pain processing mechanism
Leading cause of disability
Reticular symptoms
Pain from a nerve root
Compression of the nerve causing tingling, shooting pain, loss of power and reflexes
Dermatomal distribution resulting from involvement of a nerve root
Leg pain is worse that the back pain
Prolapsed intervertebral disc - compresses the nerve root
May continue at 6 months and 1 year
Vary in severity
Reticular symptoms; radiculopathy
Muscle weakness
Loss of sensation
Loss of reflex
Combination of these
Lumbar spinal stenosis
Pain and altered sensation in lower limbs
Caused by narrowing central spinal canal, lateral recess or foramina
Congenital or due to degenerative changes of facet joints, disc, ligamentum flavour
Symptoms possible due to venous congestion or ischemia of the nerve roots
Aggravated with walking or standing
Eased with bending forwards or sit down
Cauda equina compression
Large central disc herniation, trauma or infection
Very rare but symptoms are common
Onset or deterioration of sensory changes of perineum, bladder or bowel function, sexual dysfunction, or bilateral severe radicular pain
Symptoms have occurred/ deteriorated in past 2 weeks then an emergency referral to A&E
More than 2 weeks than an urgent referral to musculoskeletal triage service
Surgery before symptoms irreversible
Serious pathology
Fracture - osteoporotic
Inflammatory lower back pain - spondyloarthropathy
Cancer - metastatic disease > primary tumours
Spinal infection
Serious pathology: red flags
History of cancer
Progressive neurological deficits
Gait ataxia - lack of coordination
Bladder or bowel dysfunction
Saddle anaesthesia
Fever and unexplained weight loss - more than 10% of their body weight
Night pain
Trauma
Thoracic pain
Age onset less than 20 years or more than 55 years
Non-musculoskeletal lower back pain
Other systems of the body causing the lower body pain
Lower back pain/ neurological symptoms referred from non-musculoskeletal/ spinal structures
E.g. kidneys, gynaecological, neurological conditions
Biopsychosocial contributors to lower back pain: biological
Postural changes/ spinal deformity
Strength, flexibility and coordination
Inflammatory changes
Degenerative changes
Genetics
Lifestyle factors
Central pain processing - central sensitisation
Biopsychosocial contributors to lower back pain: psychological
Beliefs/ ‘cognitions’ about the nature of pain and impact of activity
Expectations about pain, recovery and treatment options
Worry and catastrophising
Pain self efficacy
Pain coping
Depression and low mood
Psychological stress, anxiety and pain related fear
Biopsychosocial contributors to lower back pain: social
Belief and attitudes of others e.g. family, friends, work colleagues
Background, culture and values
Perceived social support and isolation
Employment and workload environment
Socioeconomic factors e.g. relative deprivation, healthcare access, health literacy
