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Flashcards in this deck (27)
  • Low back pain is characterized by pain, muscle tension, or stiffness between the costal margin and inferior gluteal folds with or without leg pain.

    health pain low_back_pain
  • Low back pain is the most prevalent chronic pain syndrome, more common in women than in men.

    health pain chronic_pain
  • Low back pain is a leading cause of disability under 45 years.

    health disability pain
  • Low back pain accounts for the 2nd most frequent reason for a physician visit and the 3rd most common surgical indication.

    health statistics pain
  • Symptoms of low back pain usually improve within 8 weeks.

    health pain recovery
  • Acute low back pain lasts for less than 6 weeks, while subacute lasts from 6 to 12 weeks.

    health pain duration
  • Chronic low back pain lasts longer than 12 weeks and comprises 5-10% of cases.

    health pain chronic
  • Risk factors for low back pain include obesity, genetics, heavy lifting, smoking, pregnancy, psychosocial factors, weak trunk, occupational factors, and a sedentary lifestyle.

    health risk_factors pain
  • Most cases of low back pain are caused by nonspecific musculoskeletal pain. Degenerative changes account for 10% and herniations for 4%.

    health causes pain
  • The most common source of pain in low back issues is the facet joints.

    health anatomy pain
  • Red flag signs for low back pain include pain at rest or at night, weight loss, fever, urinary retention, incontinence, neurological weakness, a history of steroid use, and cancer.

    health red_flags pain
  • Prolonged steroid use, significant trauma, history of osteoporosis, and old age are red flags for vertebral fractures.

    health red_flags fractures
  • Signs indicating possible cancer include a history of cancer, unexplained weight loss, age (children and old), and persistent pain at night or at rest.

    health red_flags cancer
  • Fever, intravenous drug use, intractable pain, history of lumbar surgery, recent infection, and immunosuppression are red flags for infection.

    health red_flags infection
  • Severe morning stiffness lasting longer than 30 minutes that improves with activity, pain during the second half of the night, young age, alternating buttock pain, and accompanying symptoms indicate inflammatory disease.

    health inflammatory_disease pain
  • Symptoms indicating abdominal aorta aneurysms include an abdominal pulsatile mass, history of atherosclerotic disease, and old age.

    health abdominal aneurysms
  • Cauda equina syndrome is a surgical emergency caused by compression from herniation, hematomas, abscesses, or fractures resulting in fecal incontinence, urinary incontinence, saddle anesthesia, and neurological loss in the lower extremities.

    health cauda_equina emergency
  • Pain that is relieved by bending at sitting is a sign of spinal stenosis.

    health pain spinal_stenosis
  • Neural compression symptoms and signs of infection or malignancy are considered red flags.

    health red_flags malignancy
  • Psychosocial distress resulting from low back pain is referred to as a yellow flag.

    health psychosocial pain
  • Structural scoliosis is characterized by persistence during forward flexion, while functional scoliosis due to muscle spasms disappears.

    health scoliosis
  • The straight leg raise test may show radiculopathy of L5, S1, and S2, but is sensitive but not specific for L4-L5 or L5-S1 disk herniation.

    health tests pain
  • Femoral nerve stretch tests assess L2 and L3 nerve radiculopathy, but are sensitive but not specific for L1-L2 or L2-L3 herniation.

    health tests radiculopathy
  • Imaging is required if red flag signs are present, there is suspicion of underlying systemic disease or symptoms persist for more than 6-8 weeks with management.

    medical imaging diagnosis
  • MRI does not improve outcomes in early phases.

    medical mri outcomes
  • Imaging can be used if pain persists > 6-8 wks despite therapy and there are no symptoms of radiculopathy or spinal stenosis. Plain radiographs are the first option.

    medical pain imaging
  • In suspicion of a systemic disease, in surgical candidates (progressive neurological deficits), or epidural injection candidates (radiculopathy, spinal stenosis) MRI without contrast is used.

    medical mri conditions
Study Notes

Overview of Low Back Pain

Low back pain (LBP) is defined as pain and stiffness occurring between the costal margin and inferior gluteal folds, with or without leg pain.

  • Prevalence: Most common chronic pain syndrome; more frequent in women.
  • Disability: Leading cause under 45 years.
  • Physician Visits: 2nd most common reason.
  • Duration: Symptoms typically improve within 8 weeks.
  • Acute: <6 weeks
  • Subacute: 6-12 weeks, intermittent
  • Chronic: >12 weeks (5-10% of cases)

  • Risk Factors: Obesity, genetics, heavy lifting, smoking, pregnancy, psychosocial issues, weak trunk, sedentary lifestyle.

Pain Sources & Red Flags

Most LBP arises from nonspecific musculoskeletal causes:

  • Common Sources: Facet joints, degenerative changes (10%), herniations (4%).

Red Flags for Serious Conditions: - Pain at rest, significant weight loss, fever, urinary retention, neurological weakness. - History of steroid use, cancer, prolonged steroid use, significant trauma, old age (vertebral fractures). - Cancer Indicators: History of cancer, unexplained weight loss, persistent night pain. - Infection Indicators: Fever, IV drug use, recent infection, immunosuppression. - Inflammatory Disease: Severe morning stiffness >30 mins, pain worsening at night, alternating buttock pain.

Clinical Features

Specific conditions associated with LBP:

  • Cauda Equina Syndrome: Surgical emergency; symptoms include fecal/urinary incontinence, saddle anesthesia.
  • Spinal Stenosis: Pain relief noted with sitting and bending.
  • Scoliosis:
  • Structural: Persists during forward flexion.
  • Functional: Disappears during forward flexion.

Diagnostic Tests

Clinical tests and imaging for diagnosis:

  • Straight Leg Raise Test: May indicate radiculopathy (L5, S1, S2).
  • Femoral Nerve Stretch Tests: For L2 and L3 radiculopathy.

Imaging Guidelines: - Required if red flags are present or if symptoms persist >6-8 weeks. - MRI: Not useful early; indicated for progressive neurological deficits or suspicion of systemic disease. - Plain Radiographs: First imaging option if pain persists.