Approach to a case of Backache in adults.pptx

Backacke

1. Neck and backache

2. Neck and Backache Common Disabling Incur resources Treated by many specialists: Physical Medicine Physicians Orthopedicians Neurosurgeons Pain specialists

3. Key Reasons for Backache Mechanical Backache (97%) Muscle, Disc, Bone Non-mechanical Backache (2%) Tumor, Inflammation Visceral Backache (1%) Visceral Organs, Herpes

4. Clinical Pain descriptors Localized Pain – Most mechanical pains Dull persistent ache Affected by posture (Mechanical), Not affected (Visceral) Worse after rest (inflammatory) Radicular Pain – Mechanical / Non-mechanical (Neural) Sharp or shooting or electric pain Backache radiating to thigh / buttocks / calves Segmental / Multiple Dermatomes Worse by cough, sneeze, bending forward

5. Red flags in Back pain Age > 70 years Pain at rest Unexplained fever, weight loss Neurological deficit Known malignancy, trauma, Steroid use Tenderness over spine Positive SLR Intra-abdominal mass / infection Non-response to 6 weeks of conservative therapy

6. Focused Neurological Examination

7. Evaluation Any Red flag signs Look for inflammation – CBC, ESR, CRP Imaging – CT (Vertebra) / MRI (Soft tissue/cord) Neurophysiology- NCV / EMG if needed No red flag signs Conservative management Investigations if non-response to therapy

8. Acute Low Back Pain (ALBP) without Radiculopathy Duration <3 months Evaluate if Red-flag features present Spontaneous resolution well described if no-red flag Pain Relief NSAIDs / Opoids Muscle relaxants Physical Therapies Extension exercises Heat / Cold / Acupressure Massage

9. Return to activity

10. Chronic Low Back Pain (CLBP ) without Radiculopathy Duration >3 months Usually associated with Obesity, Widespread pain, Stressors Pain Relief (NSAIDs / Tricyclic anti-depressants) Uncertain benefit Exercise Therapy, Alternate therapies Electrothermal / Radiofrequency denervation Spinal fusion surgery

11. Low Back Pain with Radiculopathy Often spontaneous regression NSAIDs for pain relief Return to normal activity Nerve root blocks (Questionable benefit) Surgery if there is a neurodeficit Hemilaminectomy / Diskectomy