Back Pain Management

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Questions and Answers

Which type of back pain is characterized by pain that radiates into the lower extremity directly along the course of a spinal nerve root?

Inflammation-related back pain

Root nerve compression (correct)

Mechanical back pain

Malignancy-related back pain

What is a characteristic of mechanical back pain?

It is associated with night pain and early morning stiffness

It is more common in patients older than 50 years

It worsens with rest and improves with activity

It typically occurs for no apparent reason (correct)

Which special test is used for physical examination of back pain to assess the sacroiliac joint?

$Patrick’s$ test (FABER) (correct)

Palpation of spine processes and para-vertebral muscles

Range of motion testing in flexion, extension, lateral bending, and rotation

Straight-leg raise

In which age group is malignancy-related back pain most common?

$ ext{50 years}$ Signup and view all the answers

Which patient is most likely to require investigations based on the given indications?

$ ext{78-year-old man with new onset low back pain and metastatic prostate cancer}$ Signup and view all the answers

What is a characteristic of inflammation-related back pain?

Tenderness/inflammation over the joint Signup and view all the answers

What is an indication for investigations for back pain?

Progressive neurological findings Signup and view all the answers

Which patient case suggests a need for investigations due to age?

78-year-old man with new onset low back pain and metastatic prostate cancer Signup and view all the answers

What type of physical examination test assesses the straight-leg raise?

Special tests like Patrick’s test (FABER) Signup and view all the answers

What may be a cause of mechanical back pain?

Poor posture or lifting something awkwardly Signup and view all the answers

Which factor is not listed as a risk factor for back pain?

Younger age Signup and view all the answers

What percentage of adults experience low back pain at some point in their lives?

Up to 80% Signup and view all the answers

How long does acute back pain usually last?

Less than 6 weeks Signup and view all the answers

What is the duration range for subacute back pain?

6-12 weeks Signup and view all the answers

Which psychological factor is mentioned as a risk factor for back pain?

$ ext{Anxiety}$ Signup and view all the answers

'SOCRATES' is used for the history taking of back pain. What does 'C' stand for in 'SOCRATES'?

$ ext{Character}$ Signup and view all the answers

'Red Flags' are important in the assessment of back pain. What do 'Red Flags' indicate?

Serious underlying pathology or neurologic involvement Signup and view all the answers

Which type of pain lasts more than 12 weeks?

Chronic pain Signup and view all the answers

What type of work is listed as a risk factor for back pain?

Sedentary work Signup and view all the answers

What should be considered during history taking for back pain?

Trauma Signup and view all the answers

What is the recommended duration of bed rest for low back pain?

2 to 3 days Signup and view all the answers

Which imaging method is more sensitive than plain films for detecting spinal infections, cancers, herniated disks, and spinal stenosis?

Both MRI and CT Signup and view all the answers

What is the recommended approach for non-mechanical causes of low back pain?

Treatment of the underlying problem Signup and view all the answers

When is imaging indicated in patients with low back pain?

Without findings suggestive of serious pathology Signup and view all the answers

What type of patients may benefit from surgical treatment for low back pain?

Those who do not respond to conservative care and have disabling symptoms Signup and view all the answers

Which condition is most likely associated with the use of monoamine oxidase inhibitors?

Acute Pancreatitis Signup and view all the answers

Which receptor is associated with the drug mentioned in the text?

Agonist at adrenergic receptor Signup and view all the answers

What is the potential impact of long-term use of monoamine oxidase inhibitors?

Increased risk of serotonin syndrome Signup and view all the answers

Study Notes

One More Thing: Idea, Concern, Expectation and Emotional/Functional impact on individuals
Physical examination for back pain includes:
- Palpation of spine processes, para-vertebral muscles, and sacroiliac joint
- Inspection of the back for scoliosis, lordosis, swelling, scars, and muscle wasting
- Range of motion testing in flexion, extension, lateral bending, and rotation
- Special tests like the straight-leg raise and Patrick’s test (FABER)
Mechanical back pain:
- Can feel better or worse based on position, typically worsens with movement
- May develop suddenly or gradually, often occurs for no apparent reason
- Can sometimes be due to poor posture or lifting something awkwardly
- May be the result of a minor injury or no apparent cause
Inflammation-related back pain:
- Age at onset of back pain: 3 months
- Night pain and early morning stiffness lasting more than one hour
- Insidious onset
- Tenderness/inflammation over the joint
- Worsens with rest and improves with activity
Root nerve compression:
- Characterized by radicular pain (pain that radiates into the lower extremity directly along the course of a spinal nerve root)
- Can be due to herniated discs or other conditions impinging on nerve roots
Malignancy-related back pain:
- Most cases occur in patients older than 50 years
- More common than primary tumors of the spine
- Thoracic spine metastatic lesions are more common than lumbar
- Patients usually have constitutional symptoms such as fever, weight loss, loss of appetite, and nausea/vomiting
Different cases:
- Case 1: 38-year-old man with acute low back pain after lifting boxes
- Case 2: 20-year-old man with chronic low back pain and stiffness
- Case 3: 9-year-old male patient with severe lower back pain and radicular right leg pain
- Case 4: 78-year-old man with new onset low back pain and metastatic prostate cancer
Indications for investigations:
- Progressive neurological findings
- Constitutional symptoms
- History of traumatic onset
- History of malignancy
- Age ≥50 years
- Infectious risk such as injection drug use
- Immunosuppression
- Indwelling urinary catheter
- Prolonged steroid use
- Skin or urinary tract infection
- Osteoporosis
- Blood tests not necessary for most patients with back pain, but CBC, UA, calcium, phosphorus, (ESR), and alkaline phosphatase may be considered in some cases.
- Patients who may require long-term NSAIDs may require baseline renal and liver function tests.

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Description

Learn the common causes of back pain, how to differentiate between acute and chronic back pain, recognize red flag symptoms, and understand the investigation and management of back pain.