WEEK 7 - NON-SPECIFIC LUMBAR SPINE PAIN Flashcards
(12 cards)
Common negative beliefs regarding LBP (burden and impact)
- inevitable negative consequences
- back pain means weakness
- resting is good
- need a scan to manage
- easy to injure hard to heal
influenced by a range of modifiable and non-modifiable factors
Protective factors
cognitive - positive beliefs, high self efficacy, cognitive flexibility, acceptance
emotional factors - stress resliience, postiive mood
social factors - postiive cultural facors, supportive family and work environment, financial security, educated
physical factors - graduated physical loading, conditioned, adaptive functional behaviours
lifestyle - physically active, good sleep, health body weight, nonsmoker
Provacitve - opposite
LBP presentation
highly variable
- depends on their story
- mechanism
- sensitivty profile
- fear and beliefs
multifactorial schema
- whole person
- workplace
- pathophys
- emotional
- social
- lifestyle
- movement physical
- cognitive
Acute LBP clinical care standard - 8 quality statement
- Clinical exam
- Screen and address psychosocial factors
- Imaging only when indicated
- Provide patient education and advice
- Encourage self-management and Physical Activity
- Provide Physical and/or psychological care
- Judicious use of pain medicines
- Review and referral
Clinical exam
interview
- Screen for serious and specific causes (N.I.F.T.I.V.V)
- Mechanism – Traumatic vs Insidious
- Aggravating and Easing factors
- Irritability
- Goals and expectations
- Enquire about other potentially important contributing factors
Physical
- Observation (posture and tone)
- Functional Assessment +/- Symptom
modification procedures (SMP) - Palpation/Pain provocation tests
- ROM (AROM and PROM/PPMP)
- Possibly
- Muscle strength/capacity when linked to
the functional complaint
- Muscle strength/capacity when linked to
Screen for psychosocial factors
- Orebro
- further explore pain beliefs and concerns in all ptients with spinal pain
- social context
- high scores on single items warrant further questioning
Imaging only when indicated
- only if suspicious of serious or specific cause
- only if the imaging will help guide care
Provide education and advice
- Individualised
- Make sense of the problem for the patient
- Diagnosis
- Prognosis
- Useful and effective strategies to improve pain and function
- Cognitive re-assurance targeted directly at their concerns not general re-assurance
Prognosis
- Explain the usual course of acute NSLBP
- Most people recover within 2-6 weeks – sometimes a bit longer
- Provide a message consistent with the evidence that is hopeful and positive
- You may explain that some people don’t recover as quickly but important to target barriers of recovery so there is less risk of this happening
- Flare-ups are common
- *Even though recurrence and persistence are common it is not that useful to tell this to patients on day 1
- Symptom modification procedures related to their functional complaints and key aggravators
- Graded exposure to functional tasks
- Alter bracing and breath holding if not helpful
- Helpful Stretches
- Helpful Exercises
- Promote Physical Activity that is not pain provocative and the patient enjoys
- Mindfulness, relaxation and meditation
- Relative rest and possibly short-term avoidance
- Pain Medicines
encourage self management/physical activity
- Empower the patient with meaningful strategies
- Explain what your role as Physio will be
- Make shared-decisions with the patient about future visits and care
- Make yourself available for further support
- Provide resources in an individualised way:
- Handouts
- Recorded exercises
- Podcasts
- Websites
Provide physical an/or psychological care
- Individualised
- Targeting patient specific barriers to recovery
- Physical – Strength, movement, manual therapy, graded activity
- Psychological – Fear of movement - Graded exposure
- Social – Re-engagement in social activity, work
- Based on important contributing factors from examination
- High scores on Orebro short form don’t always mean psychologist is necessary.
judicious use of pain medicines
- non-opiod ideally
- not a pain killer - to facilitate activity
- if non-modifable, distressing and limiting function and sleep
re-evaluate and/or onward referral
- if not improving over 2-4 weeks or 2-4 sessions (by patient report or outcome measure
- quantitative
- refer onwards
- intra-disciplinary
- extra-disciplinary
- co-management or medical referral
