Back pain resident survival guide: Difference between revisions

	Back pain Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Back Pain from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X Ray
Echocardiography and Ultrasound
CT
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Non-Medical Therapy
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Lecture
Back Pain
Case Studies
Case #1
Back pain resident survival guide On the Web
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Most cited articles
Review articles
CME Programs
Powerpoint slides
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Revision as of 18:03, 26 July 2013

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief:Hilda Mahmoudi M.D., M.P.H.^[2]

Definition

Back pain is pain felt in the back that may originate from the muscles, nerves, bones, joints or other structures in the spine.

Causes

Life Threatening Causes

Abdominal aortic aneurysm

Adrenal hemorrhage

Aortic dissection

Arachnoiditis

Cauda equina syndrome

Cervical fracture

Chronic stable angina

Epidural abscess

Pulmonary embolism

Retroperitoneal hematoma

Traumatic aortic rupture

Vertebral fractures

Common Causes

Discopathy
Idiopathic lumbago
Trauma due to lifting
Ligament strain
Radiculopathy
Posterior Rami Syndrome

Management

Back pain smart algorithm

Back pain

sciatica

Yes

No

Acute radiculopathy with urinary retention, saddle anesthesia and bilateral neurologic findings
AND/OR
progressive motor weakness

C02

Yes

No

Yes

No

Proper spinal immobilization,
urgent CT or MRI to evaluate cauda equina syndrome,
Urgent neurosurgical or neurologic consultation

Order plain film of vertebra,
order ESR and/or CRP if you suspicious of osteomyelitis.

E03

Plain film and ESR/CRP are both normal

F02

Yes

No

Yes

No

Provide back pain conservative treatment for 4-6 weeks unless neurologic deficit is progressive.

H02

H03

Patient improved

I02

Yes

No

J03

J04

Reassure patient,
advise to stay active,
prescribe medication for pain if necessary,
discourage bed rest.

K02

Do's

Dont's

References

@@ Line 50: / Line 50: @@
 {{familytree | | | B01 | | | | | | | | | | | | | B02 | | |B01=Yes|B02=No}}
 {{familytree | | | |!| | | | | | | | | | | | | | |!| | | | }}
-{{familytree | | | C01 | | | | | | | | | | | | | C02 | | |C01=Acute [[radiculopathy]] with [[urinary retention]], [[saddle anesthesia]] and bilateral neurologic findings<br> AND/OR<br>Progressive motor weakness|C02=C02}}
+{{familytree | | | C01 | | | | | | | | | | | | | C02 | | |C01=Acute [[radiculopathy]] with [[urinary retention]], [[saddle anesthesia]] and bilateral neurologic findings<br> AND/OR<br>progressive motor weakness|C02=C02}}
 {{familytree | |,|-|^|-|.| | | | | | | | | | |,|-|^|-|.| | }}
 {{familytree | D01 | | D02 | | | | | | | | | D03 | | D04 |D01=Yes|D02=No|D03=Yes|D04=No}}
 {{familytree | |!| | | |!| | | | | | | | | | |!| | | |!| | }}
-{{familytree | E01 | | E02 | | | | | | | | | E03 | | |!| |E01=Proper spinal immobilization<br>Urgent [[CT]] or [[MRI]] to evaluate [[cauda equina syndrome]]<br>Urgent neurosurgical or neurologic consultation|E02=Order plain film of vertebra,<br>Order [[ESR]] and/or [[CRP]] if you suspicious of [[osteomyelitis]] |E03=E03}}
+{{familytree | E01 | | E02 | | | | | | | | | E03 | | |!| |E01=Proper spinal immobilization, <br>urgent [[CT]] or [[MRI]] to evaluate [[cauda equina syndrome]], <br>Urgent neurosurgical or neurologic consultation|E02=Order plain film of vertebra,<br>order [[ESR]] and/or [[CRP]] if you suspicious of [[osteomyelitis]]. |E03=E03}}
 {{familytree | | | | | |!| | | | | | | | | | |!| | | |!| | | | }}
-{{familytree | | | | | F01 | | | | | | | | | F02 | | |!| |F01=F01|F02=F02}}
+{{familytree | | | | | F01 | | | | | | | | | F02 | | |!| |F01=Plain film and ESR/CRP are both normal|F02=F02}}
 {{familytree | | | |,|-|^|-|.| | | | | | |,|-|^|-|.| |!| | }}
-{{familytree | | | G01 | | G02 | | | | | G03 | | G04 |!| | |G01=G01|G02=G02|G03=G03|G04=G04}}
+{{familytree | | | G01 | | G02 | | | | | G03 | | G04 |!| | |G01=Yes|G02=No|G03=Yes|G04=No}}
 {{familytree | | | |!| | | |!| | | | | | |!| | | |!| |!| | }}
-{{familytree | | | H01 | | H02 | | | | | |!| | | H03 |'| | | |H01=H01|H02=H02|H03=H03}}
+{{familytree | | | H01 | | H02 | | | | | |!| | | H03 |'| | | |H01=Provide [[back pain conservative treatment]] for 4-6 weeks  unless neurologic deficit is progressive.|H02=H02|H03=H03}}
 {{familytree | | | |!| | | | | | | | | | |!| | | |!| | | | | }}
-{{familytree | | | I01 | | | | | | | | | |!| | | I02 | | | |I01=I01|I02=I02}}
+{{familytree | | | I01 | | | | | | | | | |!| | | I02 | | | |I01=Patient improved|I02=I02}}
 {{familytree | |,|-|^|-|.| | | | | | | | |!| |,|-|^|-|.| | | |}}
-{{familytree | J01 | | J02 | | | | | | | |!| J03 | | J04 | | | |J01=J01|J02=J02|J03=J03|J04=J04}}
+{{familytree | J01 | | J02 | | | | | | | |!| J03 | | J04 | | | |J01=Yes|J02=No|J03=J03|J04=J04}}
 {{familytree | |!| | | | | | | | | | | | |!| |!| | | |!| | |}}
-{{familytree | K01 |-|-|-|-|-|-|-|-|-|-|-|'| |!| | | K02 | |K01=K01|K02=K02}}
+{{familytree | K01 |-|-|-|-|-|-|-|-|-|-|-|'| |!| | | K02 | |K01=Reassure patient,<br>advise to stay active,<br>prescribe medication for pain if necessary,<br>discourage bed rest.|K02=K02}}
 {{familytree | |!| | | | | | | | | | | | | | |!| | | | | | |}}
 {{familytree | |'|-|-|-|-|-|-|-|-|-|-|-|-|-|-|'| | | | | | |}}