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Low Back Pain: Meenakshianandi A/P Krishnan

This document discusses low back pain, which is one of the most common reasons for general practice presentations, accounting for at least 5% of cases. It notes that mechanical back pain is the main cause, accounting for around 70% of back pain presentations. The document provides details on the history, characteristics, and red flags of both acute and chronic low back pain. It also outlines the typical radiological investigations done to diagnose back pain and discusses guidelines for managing both acute and chronic low back pain, including reassurance, pain medication, continued activity, and physiotherapy or occupational therapy as needed.
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100% found this document useful (2 votes)
317 views13 pages

Low Back Pain: Meenakshianandi A/P Krishnan

This document discusses low back pain, which is one of the most common reasons for general practice presentations, accounting for at least 5% of cases. It notes that mechanical back pain is the main cause, accounting for around 70% of back pain presentations. The document provides details on the history, characteristics, and red flags of both acute and chronic low back pain. It also outlines the typical radiological investigations done to diagnose back pain and discusses guidelines for managing both acute and chronic low back pain, including reassurance, pain medication, continued activity, and physiotherapy or occupational therapy as needed.
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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LOW BACK PAIN

MEENAKSHIANANDI A/P KRISHNAN


REFERENCES
John Murtaghs general practice,5
th
edition.
Rakels Textbook of family medicine,8
th
edition.
Malaysian Low Back Pain Management Guideline, 1
st

edition.
Low back pain
Back pain- pain in the lumbosacral region, buttocks
and/or thighs, which varies with physical activity.
Low back pain atleast 5% of general practice
presentations.
The main cause of back pain presenting to the doctor-
mechanical back pain (at least 70%).
The second most common cause of back pain is
spondylosis (10%).

History Insidious onset Preciptating
injury/previous
episodes
Nature Aching, throbbing Deep dull ache, sharp
if root compression.


Stiffness Severe, prolonged
Morning stiffness
Moderate, transient

Effect of rest Exacerbates Relieves

Effect of activity Relieves Exacerbates

Radiation More localised,
bilateral or alternating
Tends to be diffuse,
unilateral
Intensity Night, early morning End of day, following
activity

'Red flag' pointers to serious low back
pain conditions 5
Age > 50 years
History of cancer
Temperature > 37.8C
Constant painday and night
Weight loss
Significant trauma
Features of
spondyloarthropathy
Neurological deficit
Drug or alcohol abuse
Use of anticoagulants
Use of corticosteroids
No improvement over 1 month
Possible cauda-equina
syndrome
saddle anaesthesia
recent onset bladder
dysfunction
severe or progressive
neurological deficit

Radiological investigations
Investigation Indication What can be diagnosed
Lumbosacral Spine
X rays AP
When acute back pain
persists for more than
2 weeks and no red flags
present

Anterior and posterior
osteophytes
Decreased disc height
Fractures
loss of vertebral height
Osteopaenia
Spondylolisthesis
Spondylolysis
Lytic lesions

MRI LS spine: If prolapsed disc and/or
nerve Disc degeneration
root or cord compression
is Disc prolapse
suspected
Spinal stenosis
Spinal cord compression
Cauda equina lesion
Metastatic disease
Infection
CT Scan pelvis If extra-spinal pathology
suspected
if Intrapelvic mass
compressing
lumbosacral plexus
Blood test
Blood tests Indication

What can be diagnosed

Full Blood Count,
Erythrocyte
Sedimentation Rate
(ESR)
Presence of fever, loss of
weight, constitutional
symptoms. Particularly in
patients with diabetes,
chronic renal failure on
dialysis.
TB / Pyogenic infection
Management of Low Back Pain
Acute Low Back Pain
Rule out red flags - i.e. exclusion of serious disease. If red flags are
present, patients should be referred immediately to a specialist-
spine or orthopaedic surgeon.
Reassurance.
Symptomatic pain relief with paracetamol or NSAIDs / COX-2
inhibitors.
Advice to continue ordinary activities as normally as possible; avoid
bed rest.
Avoidance of over-investigation at this stage.
Early return to work.
Chronic Low Back Pain (non-specific
back pain)
Activity modification
Medication
Physiotherapy
Occupational therapy
Patient education
Prevention programme
Psychological approaches
Smoking cessation (where appropriate)
Weight loss programme (when indicated)
Assistive devices / orthosis (when indicated)

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