Back pain resident survival guide

Back pain Microchapters
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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
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Case #1
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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 present?

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 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