Back Pain

Question 1

What are the functions of our spine?

Answer 1

• allows a range of movement
• protects our spinal nerves
• functions as a shock absorber

Question 2

What are the 3 curves in a normal, healthy spine?

Answer 2

• cervical lordosis
• thoracic kyphosis
• lumbar lordosis

Question 3

What is a slipped disc?

Answer 3

nucleus pulposus slips out as there is a tear in the anulus fibrosis which impinges on nerves and gives you nerve root pain (shooting pain up and down legs)

Question 4

What happens to your intervertebral discs with age?

Answer 4

discs lose water and strength and become thinner

Question 5

What factors influence mechanical back pain (the normal type)

Answer 5

• genetics
• environment - occupation
• body weight - obesity
• disproportionate muscle strength e.g body builders

Question 6

What are the features of simple back aches?

Answer 6

• classic back pain most patients present with
• first episode often sudden onset while lifting/twisting
• recurrent episodes with decreasing inter-episode frequency
• variable pain relating to position/posture - better lying flat

Question 7

What changes of the spine might appear on the X-ray of a 70 year old?

Answer 7

• facet joint changes e.g facet arthritis
• osteophytes
• disc narrowing

Question 8

What are the possible drug treatments for lower back pain?

Answer 8

• paracetamol
• NSAIDs
• opoids
• anti-depressants
• nerve modulators

Question 9

What is sciatica

Answer 9

• pain radiating from the back to the leg below the knee (if it doesn’t reach the calf it is not proper sciatica)
• sciatic nerve runs from L4 to S3
• may be associated with numbness, weakness, pins and needles, drop foot

Question 10

What is the most common cause of sciatica?

Answer 10

split disc

Question 11

What is the most common neurological sign of sciatica?

Answer 11

loss of ankle jerk

Question 12

Which 5 cancers can metastasise to bones?

Answer 12

breast, prostate, lung, kidney, thyroid

Question 13

What are red flag symptoms when diagnosing the cause of back pain?

Answer 13

• age (young or old) at first onset
• history of carcinoma
• weight loss
• constant (24h) pain > 1month
• no response to treatment
• pain worse at rest
• history of IV drug abuse or HIV positivity or immunosuppression
• infections

Question 14

What is axial spondyloarthritis?

Answer 14

• affects young people (men> women)

- pain and stiffness in spine

Question 15

what are the risk factors for osteoporosis?

Answer 15

• age
• female (loss of oestrogen after menopause)
• smoking
• steroids
• alcohol
• family history
• inflammatory conditions

Question 16

What causes osteomalacia?

Answer 16

• diet and sunlight

- low vit D

Question 17

What is Paget’s disease?

Answer 17

• raised alkaline phosphatase
• new bone formation is abnormal
• prevalence increases with age
• pelvic/back pains