• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off

Card Range To Study



Play button


Play button




Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

31 Cards in this Set

  • Front
  • Back

What are the common causes of back pain?




-muscle strain

-slipped disk

What are some other diseases that result in referred back pain?

-renal condition



-disorder of the large bowel

Is back pain all physiological?

No, psychological aspects can actually worsen back pain

What is the main goal of back pain management?

-not finding the definitive diagnosis, but rather use simplistic methods to alleviate/treat pain

Why do we want to avoid early x-rays for back pain?

-X-rays reveal everything

-may show some things wrong with the back which are not necessarily the cause of the pain --> unnecessary surgery

-wait until 6th week

Symptoms of back pain

-tightness in lower back/muscle spasms (protective of nerve)

-description of pain is not typically useful to the pharmacist = don't know what to expect, just used to determine whether to refer or not

What is the difference between neuropathic pain vs nociceptive pain?

Neuropathic - damage to or dysfunction of the nerves (NSAIDs/opiates not effective)

Nociceptive - injury to body tissues

What is the PQRST mnemonic?

p - precipitating or palliating

q - quality

r - region or radiating

s - severity

t - time

What is the role of pharmacists in back pain?

-very minimal

-decided which safe med. to use

-know when to refer

What are RED FLAGS of back pain?

- pain located high in the spine (i.e. whiplash?)

--> 2 days of new onset

- trauma (shorter height for older age) --> ASAP

-fever --> ASAP

-pain worsens when lying down --> 2 days

-numbness in bum area --> ASAP

-bladder dysf. --> ASAP

-leg pain > back pain --> make appt.

-oral steroids (withdraws Ca from bone) --> ASAP

What is CSM?

Cervical Spondylotic Myelopathy (spinal cord compression)

-neck condition

-hallmark of CSM = weakness/stiffness in the legs

Management of back pain

Usually resolves itself


30 days - 2/3 recover

3 months - 90% full recovery

Chronic - 10% suffer

How much rest post injury?

-best to return to normal activities (but not ones that strain back too much)

-muscles deteriorate fast --> work through the pain

What are patterns of back pain? Relation to pharmacists?

- Patterns = different types/degrees of back pain

(different stretches for diff patterns)

-Pharmacists --> no knowledge =/= recommendations (i.e stretches)

OTC/Prescription Analgesics - drug management of back pain

-Acetaminophen (up to 4 g/day)

-Acetylsalicylic acid (up to 4 g/day)

-Ibuprofen (OTC 1200 mg)

-Naproxen (OTC 440 mg)

Acetaminophen in back pain


-not an NSAID

- drug of choice, why? few side effects

-may not be as effective as we think


-no anti-inflammatory prop.

ASA in back pain

(Aspirin) NSAID


-anti-inflammatory prop. --> work better than

acet. ? (choice for > 18 year olds)

Ibuprofen and Naproxen in back pain

(Advil and naproxen) NSAIDs


-potential anti-inflammatory prop.

-patient can take more than OTC max (not legally tell them though)

What are some concerns with NSAIDs?

-Cardiovascular (ibuprofen)

-GI (naproxen) = all NSAIDs --> bleeding



How are antidepressants useful in back pain?

-psychological aspects (perception of pain)

-neuropathic pain

Muscle Relaxants in back pain

-not anti-spasmodic

-MOA --> sedation?

-i.e. Robaxacet, robaxacin, robaxisal

Robax products (most common)

All have methocarbamol 500

-Robax (ibup 200)

-Robaxacet (acet 325), extra strength 500)

-Robaxisal (ASA 500)

-Robaxin (just methocarbamol)

-Motrin (methocarbamol 500 + ibup 200)

combination ones preferred b/c analgesic effects

-Robaxisal --> higher GI SE but higher analgesic effect (alleviate back pain?)

Other than methocarbamol, what are other muscle relaxants?




all just as effective

-all come as combo with analgesics (only robaxacin is single relaxant )

Selecting an agent for management of back pain

1. Type of Muscle Relaxant

2. Pain analgesic or muscle relaxant or combo

-pain analgesic preferred

Heat and cold in management of back pain

-first 48 hours --> generally want cold (avoid incr inflammation)

-recurring chronic LBP - either is fine, heat can be anti-spasmodic

Topical external analgesics management in back pain

- MOA: counter irritant, massage/blood flow, psychological (odor - menthol)

- methyl salicylate (heat), menthol (cooling)

Rub A535 - slightly burns skin, can't handle both stimulants, tricks brain --> less pain, good for muscle soreness, not so much back (complex)

ICY/HOT - triggers ,cold receptors first, then same as counter irritant

How much menthol gives a cooling effect?

> 1%

Topical Diclofenac for back pain

(voltaren) extra strength is just convenience dosing (BID vs QID)

-best for muscle/joint injuries, and sprains/strains

-less SE than oral analgesics, not as effective for back area

-LBP - use in tandem with oral NSAIDs

Herbals for management of back pain

-none of great use

-glucosamine good for arthritis of simpler muscles/joints (months of treatment0

-Omega 3-fatty acids = anti-infl.

Pharmacist prescribing for back pain management

- Ibup (3200 mg/day) and Nap (1500 mg/day)

Cyclobenzaprine = muscle relaxant (neuropathic) blocks nerve impulses

-short-term use, fix underlying problem

What are the SE of cyclobenzatropine? (Flexeril)

-Dry mouth, Drowsiness (fatigue/headache less common)