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?

Facet Arthritis Signup and view all the answers

What does 'nociplastic pain' refer to?

Pain originating from the nervous system's altered perception Signup and view all the answers

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

Functional abnormalities 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)?

Regular exercise Signup and view all the answers

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

Depression and anxiety Signup and view all the answers

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

To identify clients at risk of chronic LBP Signup and view all the answers

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

Low socioeconomic status Signup and view all the answers

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

Heart disease Signup and view all the answers

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

Step 4: Recognize red flag conditions 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?

'Fear-avoidance' model Signup and view all the answers

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

'Fear-avoidance' model 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?

'Fear-avoidance' model 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?

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

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

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

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

Excessive anxiety or fear Signup and view all the answers

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

Pain neuroscience education Signup and view all the answers

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

Paracetamol Signup and view all the answers

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

Activity modification Signup and view all the answers

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

Muscle relaxants Signup and view all the answers

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

Activity avoidance behaviors Signup and view all the answers

Which of the following factors can potentially aggravate pain catastrophizing?

Financial abundance Signup and view all the answers

What is considered a significant association with chronic pain?

Magnification of pain symptoms 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?

Fear-Avoidance Belief Questionnaire (FABQ) Signup and view all the answers

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

Cognitive, emotional factors Signup and view all the answers

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

Impairment due to persistent activity avoidance behaviors Signup and view all the answers

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

'Yellow flags' Signup and view all the answers

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

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

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

'Magnification of pain symptoms' Signup and view all the answers

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

Tampa Scale for Kinesiophobia Signup and view all the answers

What does mechanical low back pain typically refer to?

Symptoms reflecting clear peripheral sensitisation Signup and view all the answers

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

NS-LBP does not have specific underlying impairments Signup and view all the answers

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

35-55 years Signup and view all the answers

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

Primary chronic pain 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?

Central Sensitisation Inventory (CSI) Signup and view all the answers

What are common risk factors for NS-LBP?

'Yellow flag' indicators Signup and view all the answers

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

Longer than three months Signup and view all the answers

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

Irritable bowel syndrome Signup and view all the answers

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

Normal or subthreshold loads Signup and view all the answers

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

Central sensitisation Signup and view all the answers

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

Involvement of spinal pathologies Signup and view all the answers

What does 'nociplastic pain' refer to?

Pain originating from the nervous system's altered perception 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)?

Adequate sleep Signup and view all the answers

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

High pain-related fear Signup and view all the answers

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

'Pain catastrophizing' Signup and view all the answers

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

Physiotherapy Signup and view all the answers

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

High scores on the Pain Catastrophizing Scale Signup and view all the answers

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

Paracetamol Signup and view all the answers

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

Implementing activity modification strategies Signup and view all the answers

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

Excessive anxiety or fear 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'?

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

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

Persistent activity avoidance behaviors Signup and view all the answers

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

Tampa Scale for Kinesiophobia Signup and view all the answers

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

Negative or threatening beliefs Signup and view all the answers

What distinguishes NS-LBP from mechanical low back pain?

Presence of structural impairments 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)?

Smoking Signup and view all the answers

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

Fear of specific movements Signup and view all the answers

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

Mechanical low back pain 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?

Central Sensitisation Inventory (CSI) Signup and view all the answers

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

Increased catastrophic thinking related to pain Signup and view all the answers

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

45-55 years Signup and view all the answers

Which condition is classified as 'primary chronic pain'?

Nociplastic pain 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?

Fear-Avoidance Belief Questionnaire (FABQ) Signup and view all the answers

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

Regular exercise Signup and view all the answers

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

'Yellow flag' indicators Signup and view all the answers

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

'Non-specific Low Back Pain' Signup and view all the answers

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

'Yellow flag' loads Signup and view all the answers

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

'Irritable bowel syndrome' 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)?

High alcohol consumption Signup and view all the answers

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

Pain catastrophizing Signup and view all the answers

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

Diabetes 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?

Physical and occupational activity Signup and view all the answers

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

Central sensitisation Signup and view all the answers

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

>20 years 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?

StarTBack screening tool Signup and view all the answers

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

>12 months Signup and view all the answers

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

'Central sensitisation' 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?

'Nociplastic' pain Signup and view all the answers

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

Superficial heat therapies (hot pack) Signup and view all the answers

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

Pain Catastrophizing Scale Signup and view all the answers

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

Encouragement for complete bed rest Signup and view all the answers

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

Complete bed rest Signup and view all the answers

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

Cognitive Functional Therapy combined with therapeutic exercise Signup and view all the answers

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

Recovery within a 6-week duration Signup and view all the answers

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

Excessive anxiety or fear Signup and view all the answers

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

Pain neuroscience education 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'?

High scores on the Pain Catastrophizing Scale 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.