- Back pain
Link:www.nice.org.uk/CG88
- Chronic if persists for > 3/12
- 3 categories
- Simple musculoskeletal pain
- Rarely goes below the knee, dull ache, lumbosacral area, generally otherwise physically well
- Discogenic in 40%. The outer layer of the disc has sensation from the grey rami communicantes
- SIJ pain 20%. Stressing the joint may reproduce the pain
- Lumbar facet joints (10%). Rotation, lateral flexion, para spinal tenderness. Can't be made by Hx and examination alone
- Ligamentous pain
- Spinal nerve root pain
- Localised, radiation in a dermatomal pattern, below knee to foot. Coughing/sneezing can exacerbate the pain. Femoral stretch +ve. Can be caused by spinal stenosis, disc lesions. Spinal stenosis commoner after 55, due to bone and ligament hypertrophy. Causes neurogenic claudication after 10-20 min walking.
- Serious spinal pathology
- Red flag
- <20 or >55
Significant trauma
Thoracic pain
Hx of cancer, steroids, IV drug abuse
Weight loss
Systemically unwell
Cauda equina
Structural deformity
Non-mechanical pain
- Yellow flag
- Negative attitude
Fear avoidance behaviour
Expectation that passive treatment will be beneficial
- Blue flag
- Social/financial barriers
- Black flag
- Management
- Drugs
- NSAIDs
- Paracetamol
- Weak opioid
- Neuropathic remedies
- Psychology
- TENS
- Spinal cord stimulus
- Accupuncture
- Physical therapies
- Epidural/caudal
- Surgery
- Nerve root and spinal stenosis
- Ix
- Serious spinal pathology
- Nerve root pain
- CT, MRI but view in context of Hx and examination
- Facet joints
- May need to diagnostic blocks, cryotherapy, RF ablation
- CEACCP
Link:ceaccp.oxfordjournals.org/content/6/4/152.full.pdf