Professional Documents
Culture Documents
Dr Sivaneasan Kandiah
General Approach
Distinguish between acute and chronic back pain
History and physical examination
Rule out bad things Red Flags
Neurological deficit
History advanced cancer
Infection
Differential Diagnosis
Mechanical
Nonmechanical causes
Infection
Inflammatory RA, SLE, Ankylosing spondylitis
Malignancy
Degenerative disease
History Taking
Pain history onset, location, severity, quality, duration,
radiation, aggravating or relieving factors
Neurological symptoms
Constitutional symptoms
Past history
Treatment
Work and lifestyle
Social and psychological issues
Red Flags
Less than 20 or older than 50, with backpain for the first time.
Trauma.
The pain is constant and getting worse.
Pain is worse at night or when supine.
Previous cancer history.
Steroid use, IV drug use, UTI, immuno-suppressed.
Fever and/or weight loss.
Neurological signs such as weakness, numbness, saddle
anesthesia or bowel/bladder incontinence
Yellow Flags
Belief that back pain is harmful and potentially disabling
Reduced activity levels
Low mood
Expectation of passive treatment rather than active
participation
Previous history of back pain and claims (time off)
Problems at work, poor job satisfaction
Overprotective family or lack of support
Physical examination
Inspection deformity, ROM
Palpation deformity, trigger points, muscle guarding
Neurological
L3-4
sensory; medial foot
Motor; knee extension
Patellar reflex
L4-5
Sensory; dorsal foot
Motor; dorsiflexion of ankle and big toe
L5-S1
Sensory; lateral foot
Motor; plantarflexion
Achilles reflex
Investigation
FBC, ESR for infection
Imaging indication
Neurological deficit
Significant h/o trauma
Signs of infection
H/o cancer
h/o osteoporosis
Acute pain lasts > 2 weeks with no red flags
Chronic pain
Multidisciplinary approach
Pain management
Activity modification, OT, PT