Low Back Pain And Whiplash

Front 1

What are red flags in back/neck pain?

Back 1

N - neurological: major motor weakness, loss of reflexes,bowel/bladder incontinence, saddle numbness
I - Infection - fever, UTI, Immunosuppressed, IV drug user
F- Fracture: trauma, osteoporosis, glucocorticoids
T - Tumour: history of cancer, weight loss, fever, pain worse supine or at night
I - inflammation: morning stiffness >1hr, age <20 or >50 / impaired consciousness (neck pain)

Front 2

What is the lifetime prevalence of Low back pain?

Back 2

70-80%

Front 3

What is the time-frame for acute, subacute, recurrent and chronic lower back pain?

Back 3

Acute: < 4 weeks (0-30 days)
Subacute: 4-12 weeks
Recurrent: <6 mo (3-6 mo: FOCUS on interrupting progress to chronic pain)
Chronic: > 6 mo

Front 4

What are the broad categories of causes of Lower Back Pain and their prevalence?

Back 4

Idiopathic/non-specific = 70%
Specific mechanical/degenerative = 27%
Red Flag Condition = 3%

Front 5

What are specific mechanical/degenerative conditions that can cause low back pain?

Back 5

Disc problems (degenerative, herniation, bulging, thinning, osteophytes)
Spinal stenosis
Spondylolisthesis

Front 6

When should you use Xrays to evaluate lower back pain?

Back 6

Acute - red flags
Chronic - specific cause is strongly suspected (ex - spinal stenosis)

Front 7

How do you treat acute low back pain pharmacologically?

Back 7

Superficial heat
Acetaminphen, +/- codeine
if it fails,
NSAIDs po/topical,
muscle relaxants (B COMeT/diazepam as relaxant)
tramadol/ other opiods

BACK TO WORK ASAP

B Baclofen -potntl ++ CNS dprsn w TCAs, opiods, BZ, anti HTNs
C Cyclobenzaprine same as B, has TCA str
O Orphenadrine same as B
Me Methocarbamol same as B
T Tizanidine -hypoT with anti HTNs, OCs reduce T's clearance, CYP1A2 inhibitors reduce Ts clearance
may increase phenytoin levels

Front 8

Pharmacologic tx of subacute LBP?

Back 8

similar to acute
pcm +/- codeine
tramadol
msl relaxants


fail: some cases you may try opiods

Front 9

How do you treat chronic low back pain pharmacologically? CBT is always recommended

Back 9

short term relief with:
-msl relaxants
-BZDs
-antispastics
-gabapentin/pregabalin (MAY HELP-limited evidence)
- tramadol (some evidence)

also can try:
trigger point blocks: LAs, epidural steroids (limited evidence)

if all else fails, try opiods: USE SR!

note: Cymbalta approved for chronic LBP but place in tx undetermined.

Front 10

What percent of lower back pain becomes chronic?

Back 10

5-8% (most recover within 4 weeks)

Front 11

What is the timeline for acute, subacute and chronic related to time from whiplash injury?

Back 11

Acute = <1 wk reduce distress, need surgery??
1-4 wks: Restore fctn, normal activities ASAP
Subacute 4-12wks encourage back to WORK
Chronic >6mo manage chronic pain, restore fctn and independence

Front 12

What is the classification of Whiplash Associated Disorders (WADs)?

Back 12

I - Neck symptoms (pain/stiff), no physical signs/limitations
II - Neck symptoms and reduced range
III - Neck symptoms and neurological signs, NO fx
IV - Neck symptoms and fracture(fx)/DISLOCATION

Front 13

What percentage of cases of whiplash associated disorder fall into each of the quebec task force grades?

Back 13

I & II - 80%
III - 20%
IV - rare

Front 14

What are typical complaints associated with whiplash disorder?

Back 14

Neck/shoulder/arm pain or stiffness
Headache
Restricted neck ROMovement
Dizziness

Front 15

What are treatment recommendations for grade I/II whip lash disorder (acute and chronic)?

Back 15

Acute - Early mobilization, avoid neck collar, analgesics, NSAIDs (inconclusive evidence for its use in neck pain), muscle relaxants, exercises, not enough evidence for alternative medicine
Chronic - exercises, insufficient evidence for alternative medicine