Diagnostic Imaging for Low Back Pain (LBP)

Diagnostic Imaging for LBP

• Abnormal radiology pattern is not a reliable indicator of LBP causes
• Asymptomatic patients over 60 years old:
  • 36% have disc herniation
  • 21% have spinal stenosis
  • >90% have disc degeneration

Indications of Radiology Study for LBP

• Not specified in the text

Pharmacologic Treatment for LBP

• Pain pathway and pharmacological interventions:
  • Local anaesthetics, antihistamines, and anti-inflammatory agents for direct pain relief at the site of injury
  • Opioids and non-opioid drugs (e.g. morphine, cannabinoids, COX-2 inhibitors, α2 agonists, gabapentin, acetaminophen, and tricyclic anti-depressants) acting peripherally and centrally to attenuate pain signaling transmission

Interventional Techniques for LBP

• Steroid injection and neural blockade
• Deep brain stimulation (DBS)
• Percutaneous neuromodulation therapy (PENS)
• Spinal cord stimulation
• Transcranial and epidural stimulation
• Neuroablative procedures
• Stimulation of dorsal root ganglia (DRG) and peripheral nerve or nerve field

Summary

• LBP must be addressed as a complex disease requiring accurate diagnosis of pain generators before treatment
• Multimodal and multidisciplinary approach is essential to determine a strategy to solve the problem, not just alleviate symptomatic pain
• Careful follow-up is necessary to adapt therapeutic strategies to dynamic clinical manifestations of CLBP

Diagnostic Procedures for LBP

Anamnesis

• Specific radicular pain or spinal stenosis
• Non-specific LBP

Red Flags

• Not specified in the text

Yellow Flags

• Not specified in the text

Physical Examinations

• Disc herniation:
  • SLR positive: Sens 91%, Spec 26%
  • Crossed SLR: Sens 29%, Spec 88%
  • Centralization phenomenon: increases
• Spinal stenosis:
  • 20% asymptomatic
  • Diagnosis based on history and PE
  • Neurogenic claudication (pseudoclaudicatio)
• Facet joint pain:
  • Degeneration process
  • Spine injury
  • Fracture
  • Tear ligamentum flavum
  • Disc problem

Sacroiliac Joint Pain

• Distraction test
• Compression test
• Thigh thrust test
• Patrick's sign
• Gaenslen's test
• SI joint block: moderate specificity and validity
• Radiology diagnosis: not accurate
• Bone scan: sensitivity is low/limited

Myofascial Low Back Pain

• Quadratus Lumborum
• Gluteus medius
• Para iliopsoas
• Abdominis rektus

Back Pain

• Definition: a complex unpleasant phenomenon composed of sensory experiences including time, space, intensity, emotion, cognition, and motivation
• Yearly prevalence: 5-65%
• Lifetime prevalence: up to 84%
• Monthly prevalence: 35-37%
• High rate of disability and medical costs associated with back pain

This quiz covers the role of diagnostic imaging in low back pain, including abnormal radiology patterns and pharmacological treatment options. It also explores the pain pathway and pharmacological interventions.