Non-specific Low Back Pain (NS-LBP)
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Questions and Answers

Which term is used to describe back pain that is not attributed to serious spinal pathologies or specific lumbopelvic conditions?

  • Nociplastic Pain
  • Mechanical Low Back Pain
  • Central Sensitisation
  • Non-specific Low Back Pain (correct)

    • What is the underlying mechanism of altered nervous system function in clients with nociplastic pain?

  • Muscle and Joint Sprain
  • Spondylarthritis
  • Vertebral Fractures
  • Central Sensitisation (correct)

    • What term is often used interchangeably with 'Non-specific Low Back Pain' in musculoskeletal practice?

  • Nociplastic Pain
  • Discogenic Pain
  • Mechanical Low Back Pain (correct)
  • Spondylolisthesis

    • Which of the following is a red flag condition that can cause low back pain?

    <p>Facet Arthritis</p> Signup and view all the answers

    What does 'nociplastic pain' refer to?

    <p>Pain originating from the nervous system's altered perception</p> Signup and view all the answers

    In individuals with nociplastic pain, what may or may not present along with central sensitisation?

    <p>Functional abnormalities</p> Signup and view all the answers

    Which lifestyle factor is NOT mentioned as a risk factor for the development of chronic or persistent non-specific low back pain (NS-LBP)?

    <p>Regular exercise</p> Signup and view all the answers

    Which psychological factor is considered an important indicator for the development of chronic or persistent NS-LBP?

    <p>Depression and anxiety</p> Signup and view all the answers

    What is StarTBack commonly used for in clinical assessments related to back pain?

    <p>To identify clients at risk of chronic LBP</p> Signup and view all the answers

    Which social factor is mentioned as a potential risk factor for NS-LBP?

    <p>Low socioeconomic status</p> Signup and view all the answers

    What biological comorbidity is NOT listed as a risk factor for NS-LBP?

    <p>Heart disease</p> Signup and view all the answers

    What are the common steps that should be considered before diagnosing NS-LBP?

    <p>Step 4: Recognize red flag conditions</p> Signup and view all the answers

    'Individuals who catastrophize about the meaning of their pain may become fearful and subsequently avoid physical and/or occupational activity' - This statement aligns with which model?

    <p>'Fear-avoidance' model</p> Signup and view all the answers

    'Greater than 50% of individuals with LBP experience high pain-related fear' - This is a finding that supports:

    <p>'Fear-avoidance' model</p> Signup and view all the answers

    'Engaging clients with normal activity in the absence of catastrophic thoughts leads to good functional recovery' - Which concept does this statement support?

    <p>'Fear-avoidance' model</p> Signup and view all the answers

    'There might not be a single method or diagnostic tool to identify and diagnose NS-LBP' - Why is this statement made?

    <p>'No reliable tests exist for NS-LBP diagnosis'</p> Signup and view all the answers

    What is a common impairment-based classification for individuals with Chronic LBP and generalised pain symptoms?

    <p>Acute and subacute low back pain with related cognitive and affective tendencies</p> Signup and view all the answers

    What does a high score on the Fear-Avoidance Belief Questionnaire (FABQ) suggest about an individual?

    <p>Excessive anxiety or fear</p> Signup and view all the answers

    Which non-pharmacological management option is recommended as a first-line treatment for individuals with NS-LBP?

    <p>Pain neuroscience education</p> Signup and view all the answers

    What is NOT recommended for individuals with NSLBP according to the presented text?

    <p>Paracetamol</p> Signup and view all the answers

    Which therapeutic approach combines Cognitive Functional Therapy with various strategies for individuals with NS-LBP?

    <p>Activity modification</p> Signup and view all the answers

    What is a common pharmaceutical second-line treatment option for individuals with NS-LBP according to the text?

    <p>Muscle relaxants</p> Signup and view all the answers

    What is a common characteristic associated with chronic pain according to the text?

    <p>Activity avoidance behaviors</p> Signup and view all the answers

    Which of the following factors can potentially aggravate pain catastrophizing?

    <p>Financial abundance</p> Signup and view all the answers

    What is considered a significant association with chronic pain?

    <p>Magnification of pain symptoms</p> Signup and view all the answers

    What is a common client self-reported subjective assessment tool used to measure fear-avoidance behaviors in chronic musculoskeletal pain?

    <p>Fear-Avoidance Belief Questionnaire (FABQ)</p> Signup and view all the answers

    What are examples of psychological factors that may influence chronic pain?

    <p>Cognitive, emotional factors</p> Signup and view all the answers

    What is one of the consequences of chronic pain mentioned in the text?

    <p>Impairment due to persistent activity avoidance behaviors</p> Signup and view all the answers

    Which factor is not part of the social dimensions influencing chronic pain?

    <p>'Yellow flags'</p> Signup and view all the answers

    What can information gathered about the severity of pain symptoms help identify according to the text?

    <p>'Potential clients at higher risk of developing chronic pain syndromes'</p> Signup and view all the answers

    'Pain catastrophizing' is associated with which of the following beliefs?

    <p>'Magnification of pain symptoms'</p> Signup and view all the answers

    What tool is commonly used to measure kinesiophobia in clients with chronic musculoskeletal pain symptoms?

    <p>Tampa Scale for Kinesiophobia</p> Signup and view all the answers

    What does mechanical low back pain typically refer to?

    <p>Symptoms reflecting clear peripheral sensitisation</p> Signup and view all the answers

    How is NS-LBP different from mechanical low back pain?

    <p>NS-LBP does not have specific underlying impairments</p> Signup and view all the answers

    What is the age range where NS-LBP is most common?

    <p>35-55 years</p> Signup and view all the answers

    What is the classification of NS-LBP according to the ICD-11?

    <p>Primary chronic pain</p> Signup and view all the answers

    Which tool can be used at the early stage of clinical assessment to identify clients at risk of developing chronic NS-LBP?

    <p>Central Sensitisation Inventory (CSI)</p> Signup and view all the answers

    What are common risk factors for NS-LBP?

    <p>'Yellow flag' indicators</p> Signup and view all the answers

    'Primary chronic pain' is defined as pain that persists for how long?

    <p>Longer than three months</p> Signup and view all the answers

    'Primary chronic visceral pain' can be exemplified by which condition?

    <p>Irritable bowel syndrome</p> Signup and view all the answers

    'Central sensitisation' is a key indicator of abnormal pain perception caused by what type of loads?

    <p>Normal or subthreshold loads</p> Signup and view all the answers

    What is the underlying mechanism of altered nervous system function in clients with nociplastic pain?

    <p>Central sensitisation</p> Signup and view all the answers

    How is non-specific low back pain (NS-LBP) different from mechanical low back pain?

    <p>Involvement of spinal pathologies</p> Signup and view all the answers

    What does 'nociplastic pain' refer to?

    <p>Pain originating from the nervous system's altered perception</p> Signup and view all the answers

    What lifestyle factor is NOT mentioned as a risk factor for the development of chronic or persistent non-specific low back pain (NS-LBP)?

    <p>Adequate sleep</p> Signup and view all the answers

    What do high scores on the Fear-Avoidance Belief Questionnaire (FABQ) suggest about an individual?

    <p>High pain-related fear</p> Signup and view all the answers

    'Greater than 50% of individuals with LBP experience high pain-related fear' - This finding supports:

    <p>'Pain catastrophizing'</p> Signup and view all the answers

    What is a primary recommended non-pharmacological management option for individuals with NS-LBP?

    <p>Physiotherapy</p> Signup and view all the answers

    What is a characteristic of individuals with NS-LBP according to the text?

    <p>High scores on the Pain Catastrophizing Scale</p> Signup and view all the answers

    Which second-line pharmacological treatment option is NOT recommended for individuals with NS-LBP according to the text?

    <p>Paracetamol</p> Signup and view all the answers

    What is a key aspect of Cognitive Functional Therapy for individuals with NS-LBP?

    <p>Implementing activity modification strategies</p> Signup and view all the answers

    Which belief is consistent with high scores on the Fear-Avoidance Belief Questionnaire (FABQ) according to the text?

    <p>Excessive anxiety or fear</p> Signup and view all the answers

    Which factor is associated with the classification of 'Acute and subacute low back pain with related cognitive and affective tendencies'?

    <p>'NS-LBP usually recover within a 6-week duration'</p> Signup and view all the answers

    What is a common characteristic of chronic pain according to the text?

    <p>Persistent activity avoidance behaviors</p> Signup and view all the answers

    Which subjective assessment tool is commonly used to measure kinesiophobia in clients with chronic musculoskeletal pain symptoms?

    <p>Tampa Scale for Kinesiophobia</p> Signup and view all the answers

    What is a significant association with chronic pain based on the text?

    <p>Negative or threatening beliefs</p> Signup and view all the answers

    What distinguishes NS-LBP from mechanical low back pain?

    <p>Presence of structural impairments</p> Signup and view all the answers

    Which lifestyle factor is NOT mentioned as a risk factor for the development of chronic or persistent non-specific low back pain (NS-LBP)?

    <p>Smoking</p> Signup and view all the answers

    Which psychological factor is a common risk indicator for developing chronic NS-LBP?

    <p>Fear of specific movements</p> Signup and view all the answers

    What term is often used interchangeably with 'Non-specific Low Back Pain' in musculoskeletal practice?

    <p>Mechanical low back pain</p> Signup and view all the answers

    What tool is typically used in early clinical assessment to identify clients at risk for chronic NS-LBP due to central sensitisation?

    <p>Central Sensitisation Inventory (CSI)</p> Signup and view all the answers

    What does a high score on the Pain Catastrophizing Scale suggest about an individual?

    <p>Increased catastrophic thinking related to pain</p> Signup and view all the answers

    What is the age group where NS-LBP is most commonly experienced?

    <p>45-55 years</p> Signup and view all the answers

    Which condition is classified as 'primary chronic pain'?

    <p>Nociplastic pain</p> Signup and view all the answers

    Which tool can be used at the early stage of clinical assessment to identify clients at risk of developing chronic NS-LBP?

    <p>Fear-Avoidance Belief Questionnaire (FABQ)</p> Signup and view all the answers

    What lifestyle factor is NOT mentioned as a common risk factor for developing chronic NS-LBP?

    <p>Regular exercise</p> Signup and view all the answers

    What is the defining characteristic of 'Primary Chronic Pain' according to the text?

    <p>'Yellow flag' indicators</p> Signup and view all the answers

    Which term is used to describe back pain that cannot be attributed to specific structural impairments?

    <p>'Non-specific Low Back Pain'</p> Signup and view all the answers

    'Central sensitisation' as a risk indicator refers to abnormal pain perception caused by what type of loads?

    <p>'Yellow flag' loads</p> Signup and view all the answers

    'Primary Chronic Visceral Pain' can be exemplified by which condition?

    <p>'Irritable bowel syndrome'</p> Signup and view all the answers

    What lifestyle factor is identified as a significant risk factor for the development of chronic or persistent non-specific low back pain (NS-LBP)?

    <p>High alcohol consumption</p> Signup and view all the answers

    Which psychological factor is considered an important indicator for the development of chronic or persistent NS-LBP?

    <p>Pain catastrophizing</p> Signup and view all the answers

    What biological comorbidity is NOT listed as a risk factor for NS-LBP?

    <p>Diabetes</p> Signup and view all the answers

    According to the Fear-Avoidance model, what do individuals with LBP avoid to reduce the likelihood of re-experiencing pain?

    <p>Physical and occupational activity</p> Signup and view all the answers

    What is a key indicator of abnormal pain perception in individuals with NS-LBP?

    <p>Central sensitisation</p> Signup and view all the answers

    Which age group is most commonly associated with NS-LBP according to the text?

    <p>&gt;20 years</p> Signup and view all the answers

    What tool is frequently used at the early stage of clinical assessment to identify clients at risk of developing chronic LBP?

    <p>StarTBack screening tool</p> Signup and view all the answers

    'Primary chronic pain' is defined as pain persisting for how long?

    <p>&gt;12 months</p> Signup and view all the answers

    'Nociplastic pain' typically presents with which of the following?

    <p>'Central sensitisation'</p> Signup and view all the answers

    'Pain involvement is unclear to specific loading direction and/or motion restrictions' typically refers to what type of back pain?

    <p>'Nociplastic' pain</p> Signup and view all the answers

    What is a common conservative management approach for individuals with non-specific low back pain (NS-LBP)?

    <p>Superficial heat therapies (hot pack)</p> Signup and view all the answers

    Which tool is recommended as a second-line treatment option for individuals with NS-LBP?

    <p>Pain Catastrophizing Scale</p> Signup and view all the answers

    What is a potential consequence of high scores on the Fear-Avoidance Belief Questionnaire (FABQ)?

    <p>Encouragement for complete bed rest</p> Signup and view all the answers

    Which lifestyle factor is NOT recommended as a first-line treatment for individuals with NS-LBP?

    <p>Complete bed rest</p> Signup and view all the answers

    Which is a common non-pharmacological first-line treatment option for individuals with NS-LBP?

    <p>Cognitive Functional Therapy combined with therapeutic exercise</p> Signup and view all the answers

    What characteristic is consistent with high scores on the Pain Catastrophizing Scale?

    <p>Recovery within a 6-week duration</p> Signup and view all the answers

    What does high scores on the Fear-Avoidance Belief Questionnaire (FABQ) suggest about an individual with NS-LBP?

    <p>Excessive anxiety or fear</p> Signup and view all the answers

    What is a primary recommended non-pharmacological management option for individuals with NS-LBP?

    <p>Pain neuroscience education</p> Signup and view all the answers

    According to the ICF impairment-based classification, what is consistent with individuals classified as 'Acute and subacute low back pain with related cognitive and affective tendencies'?

    <p>High scores on the Pain Catastrophizing Scale</p> Signup and view all the answers

    Study Notes

    Non-Specific Low Back Pain (NS-LBP)

    • Defined as back pain that is not attributable to underlying serious spinal pathologies or specific lumbopelvic conditions
    • Often referred to as nociplastic-LBP, characterized by persistent pain originating from the nervous system's altered perception
    • Term 'central sensitisation' refers to the underlying mechanism of altered nervous system function in clients with nociplastic pain

    Modifiable Lifestyle Factors

    • Smoking
    • Alcohol consumption
    • Physical inactivity (sedentary behaviours)
    • TV watching
    • Diet
    • Poor family functioning
    • Socioeconomic status

    Psychological and Cognitive-Behavioural Factors

    • Depression and anxiety
    • Negative belief in back pain
    • Poor coping and hyper-vigilance behaviour to pain
    • Pain catastrophizing
    • Fear-avoidance behaviour or Kinesiophobia
    • Mental health disorders

    Biological Comorbidities

    • Genetics
    • Age (14 to 17, >20 years)
    • Sex (female > male)
    • Obesity
    • Asthma
    • Kidney disease
    • Vitamin-D deficiency
    • Hypothyroidism
    • Arthritis
    • Osteoporosis
    • Tissue and central sensitisation

    Understanding and Diagnosing NS-LBP

    • Identify common signs and symptoms
    • Screen for red flag conditions
    • Identify cognitive, behavioral, and interpersonal risk factors
    • Use StarTBack, a valid back pain screening tool, to identify clients at risk of developing chronic LBP

    Fear-Avoidance Model

    • Proposes that individuals who catastrophize about the meaning of their pain may become fearful and subsequently avoid physical and/or occupational activity
    • Leads to reduced quality of life or wellbeing associated with physical activity

    Management of NS-LBP

    • Avoid bed rest and activity restrictions
    • Physiotherapy: pain physiology education, cognitive functional therapy, manual therapy, and self-management strategies
    • Superficial heat therapies, spinal mobilisation, and other complementary therapies
    • Pain medications: NSAIDs and muscle relaxants

    Biopsychosocial Model

    • Involves biological, psychological, and social factors
    • Helps identify potential clients at higher risk of developing chronic pain syndromes### Classification of Low Back Pain
    • Acute and subacute low back pain with related cognitive and affective tendencies is classified as a condition in the ICF impairment-based classification (Delitto et al., 2012)
    • High scores on the Fear-Avoidance Belief Questionnaire (FABQ) indicate excessive anxiety or fear
    • High scores on the Pain Catastrophizing Scale indicate cognitive dysfunctions such as high helplessness, rumination, or pessimism about LBP

    Management of Non-Specific Low Back Pain (NS-LBP)

    • NS-LBP usually recovers within 6 weeks with relevant mechanisms and impairment-based interventions targeting physical activity, client education, and pain medication
    • Evidence-based non-pharmacological and pharmacological management recommended for individuals with NSLBP:
      • Primary/first-line treatment:
        • Avoid bed rest and activity restrictions
        • Physiotherapy
        • Pain physiology education
      • Second-line treatment:
        • Superficial heat therapies
        • Spinal mobilisation
        • Massage and acupuncture
        • Pain medications (NSAIDs and muscle relaxants)
    • Paracetamol has no benefit or is not recommended

    Mechanical Low Back Pain

    • Refers to symptoms of low back pain that reflect clear peripheral sensitization (nociception and/or neuropathic) pain features specific to muscle, facet joint, disc, nerve, and bony dysfunction
    • Differentiating muscle, joint, and disc dysfunction related mechanical pain can be difficult to differentiate at times

    Non-Specific Low Back Pain (NS-LBP)

    • Defined as back pain that is not attributable to underlying serious spinal pathologies (red flags) or specific lumbopelvic conditions
    • Most common between the ages of 35 and 55 years, as well as experienced during childhood and adolescent years
    • Classified as 'primary chronic pain' (Nicholas et al., 2019; ICD-11)

    Risk Factors of NS-LBP

    • Repetitive stress: heavy physical activity, prolonged static postures
    • Central sensitisation: abnormal pain perception and/or intense enhancement of pain caused by normal or subthreshold physical loads
    • Modifiable lifestyle factors: smoking, alcohol, physical inactivity, TV watching, diet
    • Psychological and cognitive-behavioural factors: depression, anxiety, negative belief in back pain, poor coping, hyper-vigilance, pain catastrophizing, fear-avoidance behaviour
    • Social factors: poor family functioning, socioeconomic status
    • Biological comorbidities: genetics, age, sex, obesity, asthma, kidney disease, vitamin D deficiency, hypothyroidism, arthritis, osteoporosis, tissue and central sensitisation

    Understanding and Diagnosing NS-LBP

    • No single method or diagnostic tool to identify and diagnose NS-LBP
    • Steps to diagnose NS-LBP:
      1. Identify common signs and symptoms
      2. Screen for red flag conditions
      3. Understand and identify clinical features of central sensitisation (nociplastic pain)
      4. Understand and identify cognitive, behavioral, and interpersonal risk factors

    Fear-Avoidance Model

    • Established by Vlaeyen and Linton (2000)
    • Proposes that individuals who catastrophize about the meaning of their pain may become fearful and subsequently avoid physical and/or occupation activity to reduce the likelihood of re-experiencing pain or causing further physical damage, which leads to reduced quality of life or wellbeing associated with physical activity### Chronic Pain and Non-Specific Low Back Pain (NS-LBP)
    • Chronic pain is a multifactorial biopsychosocial phenomenon that interrupts and interferes with a person's quality of life in many ways.
    • NS-LBP is defined as back pain that is not attributable to underlying spinal pathologies or specific lumbopelvic conditions.

    Fear-Avoidance Model

    • The fear-avoidance model proposes that individuals who catastrophize about the meaning of their pain may become fearful and avoid physical activity, leading to reduced quality of life or wellbeing.
    • The model suggests that when clients experience LBP for the first time, engaging them in normal activity in the absence of catastrophic thoughts leads to good functional recovery.

    Aggravating Factors of Pain Catastrophising

    • Inappropriate communication of diagnosis or its cause and complication-related misunderstanding
    • Less or poor support of family, friends, and social environment
    • Financial constraints
    • Poor interpersonal relationship

    Biopsychosocial Model of Low Back Pain Care

    • The biopsychosocial model consists of four factors: biological, social, psychological, and extensions (including interpersonal aspects, patient-centered care, and therapeutic alliance)
    • Sub-factors under each category include:
      • Biological: pain neurophysiology education, pain intensity, pain location, physical disability, posture, and range of motion
      • Social: work, family relationships, socioeconomic status, living situation, and environment
      • Psychological: behavior, cognition, attitudes, beliefs, yellow flags, mental health, rapport, and mood
      • Extensions: interpersonal aspects, patient-centered care, therapeutic alliance, stigma, discrimination, culture, language, and screening cognitive and emotional dysfunction in NS-LBP

    Screening Cognitive and Emotional Dysfunction in NS-LBP

    • Fear-Avoidance Belief Questionnaire (FABQ)
    • Fear-Avoidance Components Scale
    • Tampa Scale for Kinesiophobia
    • Pain Catastrophizing Scale

    Management of NS-LBP

    • Avoid bed rest and activity restrictions
    • Physiotherapy (primary/first-line treatment)
      • Pain physiology education (pain neuroscience education)
      • Encourage clients to reduce pain and stay active
      • Cognitive Functional Therapy combined with therapeutic exercise, manual therapy, and self-management strategies (activity modification)
    • Second-line treatment options:
      • Superficial heat therapies (hot pack)
      • Spinal mobilization
      • Massage and acupuncture
      • Pain medications: NSAIDs and muscle relaxants
      • Paracetamol has no benefit (or is not recommended)

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    Description

    Test your knowledge on non-specific low back pain (NS-LBP), which is back pain not caused by serious spinal pathologies or specific lumbopelvic conditions. This quiz covers the characteristics, risk factors, diagnosis, and management of NS-LBP.

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