5 Questions
What is the typical duration of chronic back pain?
More than 12 weeks
What can cause acute back pain?
Physical injury or incorrect movement
What is pain composed of, according to the text?
Time, space, intensity, emotion, cognition, and motivation
What is the range of lifetime prevalence of back pain?
5% to 65%
What can result from back pain, according to the text?
Escalation in medical costs
Study Notes
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.
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