28 Questions
Which type of back pain is characterized by pain that radiates into the lower extremity directly along the course of a spinal nerve root?
Root nerve compression
What is a characteristic of mechanical back pain?
It typically occurs for no apparent reason
Which special test is used for physical examination of back pain to assess the sacroiliac joint?
$Patrick’s$ test (FABER)
In which age group is malignancy-related back pain most common?
$ ext{50 years}$
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}$
What is a characteristic of inflammation-related back pain?
Tenderness/inflammation over the joint
What is an indication for investigations for back pain?
Progressive neurological findings
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
What type of physical examination test assesses the straight-leg raise?
Special tests like Patrick’s test (FABER)
What may be a cause of mechanical back pain?
Poor posture or lifting something awkwardly
Which factor is not listed as a risk factor for back pain?
Younger age
What percentage of adults experience low back pain at some point in their lives?
Up to 80%
How long does acute back pain usually last?
Less than 6 weeks
What is the duration range for subacute back pain?
6-12 weeks
Which psychological factor is mentioned as a risk factor for back pain?
$ ext{Anxiety}$
'SOCRATES' is used for the history taking of back pain. What does 'C' stand for in 'SOCRATES'?
$ ext{Character}$
'Red Flags' are important in the assessment of back pain. What do 'Red Flags' indicate?
Serious underlying pathology or neurologic involvement
Which type of pain lasts more than 12 weeks?
Chronic pain
What type of work is listed as a risk factor for back pain?
Sedentary work
What should be considered during history taking for back pain?
Trauma
What is the recommended duration of bed rest for low back pain?
2 to 3 days
Which imaging method is more sensitive than plain films for detecting spinal infections, cancers, herniated disks, and spinal stenosis?
Both MRI and CT
What is the recommended approach for non-mechanical causes of low back pain?
Treatment of the underlying problem
When is imaging indicated in patients with low back pain?
Without findings suggestive of serious pathology
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
Which condition is most likely associated with the use of monoamine oxidase inhibitors?
Acute Pancreatitis
Which receptor is associated with the drug mentioned in the text?
Agonist at adrenergic receptor
What is the potential impact of long-term use of monoamine oxidase inhibitors?
Increased risk of serotonin syndrome
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.
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.
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