Back pain Management & Treatment

Role of Primary Health Care in Management

Goals for Treatment

• Educate patient about the natural history of back pain.
• Ask about and address the patient’s concerns and goals.
• Reduce pain.
• Maximize functional status and increase quality of life.
• Exercises: to help them return to normal activities and work. These exercises usually involve stretching maneuvers.

The management is according to the cause.

Pharmacological Management

• Pharmacological
  • Oral drugs
    • NSAID
    • “Ibuprofen”
    • Analgesics
    • Antidepressant
    • Muscle relaxant
  • Local injection
    • Epidural Steroid
    • Trigger point and ligaments
  • Non-drug
    • Heat therapy
    • Physiotherapy
    • Acupuncture

When Should Patients Be Referred to a Specialist?

Indications for Immediate Referral

• Cauda equina syndrome. (Immediate referral)
• Severe or progressive neurologic deficits.
• Infections.
• Tumors.
• Fractures compressing the spinal cord.
• No response to conservative therapy.

Prevention of Back Pain

Recommendations for the General Population

• Explain non-specific causes of low back pain.
• Encourage an active lifestyle and to make exercise such as walking, jogging, swimming, etc.
• Occupational health must be emphasized to prevent lots of diseases, one of which is back pain.

How to Protect Your Back

• In Sitting:
  • Support your back against a hard chair.
  • Make sure your hips level is higher than your knees.
• In Standing:
  • Never lean forward without bending your knees.
• Sleeping:
  • Don’t sleep on your stomach.
• Lifting:
  • Avoid sudden movements.
  • Bend both knees with leg muscles to lift them up.
  • Keep the load closer to your body and try not to lift anything higher than.

Post Test

Questions

1. Which of the following is not a risk factor for back pain:

   • A. Obesity.
   • B. Heavy physical work.
   • C. Ethnicity.
   • D. Stress and distress.

2. A patient came with lower back pain with morning stiffness exacerbated by rest and relieved by activity:

   • A. Mechanical back pain
   • B. Inflammatory back pain
   • C. Tumor
   • D. Nerve root compression

3. All of the following are red flag signs of back pain except:

   • A. Onset age either <20 or >55 years.
   • B. Duration less than 6 weeks.
   • C. Bowel or bladder dysfunction.
   • D. Spinal deformity.

4. Medical Case Study:

   • 30-year-old woman had low backache 3 days ago, while taking further history, she said that they were moving to a new house and she was lifting heavy objects, the most probable diagnosis is:
     1. Spinal stenosis.
     2. Prolapsed disc.
     3. Rheumatoid arthritis.
     4. Fracture.
     5. Non-Specific LBP

5. Most common site for disk prolapsed is:

   • A. L4 and L5 ←
   • B. S1 and S2
   • C. C4
   • D. L1 and L2