Low Back Pain Ppt Powerpoint Presentation slides Dr. Kishore Nallapu Medical Slideshow Chronic Pain - Cymbalta Study Shows Reduction in Chronic Low Back Pain

Low Back Pain

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mido on Oct 14, 2009 Says :

I think this presentation about LBP is the most suitable and it is covering simply all aspects and outline approachto LBP

Syed Farooq on May 03, 2009 Says :

low back pain is the most causes of referal to the doctor.

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Notes

Show Notes

Slide 1 :

Low Back Pain Dr.Kishore Nallapu

Slide 2 :

Goals To recognize red flags To recognize yellow flags To recognize disability from simple low back pain To relieve pain To improve ability to function and alleviate disability To prevent recurrence and the development of chronicity

Slide 3 :

How Common? 4% of GP consultations. £1632 million (1998). 800,000 in-patient bed-days. 52 million lost working days each year in Britain. Lifetime prevalence is. -- >80% in adults. -- >40% in adolescents. Men and women are equally affected. Aged 30 to 50.

Slide 4 :

How Common Are Serious Causes ? <5% have true nerve root pain <1% have serious disease such as spinal tumour or infection <1% have inflammatory disease such as ankylosing spondylitis

Slide 5 :

Anatomy

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Slide 7 :

Anatomy

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Slide 11 :

Risk factors Heavy physical work Lifting and handling of loads Awkward postures and movements Whole body vibration (truck driving) Trauma

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Causes Mostly unknown (simple low back pain) Traumatic Referred pain Degenerative Inflammatory Infective Neoplastic Metabolic etc

Slide 13 :

Referred pain Abdomen: aortic aneurysm Kidney: pyelonephritis, hydronephrosis, calculi, tumour, perinephric abscess Ovary: cysts, cancer Pelvis: endometriosis, period pain, pelvic inflammatory disease Bladder: infections

Slide 14 :

Degenerative and Structural Spondylosis Spondylolisthesis Gross scoliosis and/or kyphosis

Slide 15 :

Inflammatory Conditions Ankylosing spondylitis Polymyalgia rheumatica Rheumatoid arthritis (rarely) Coccydynia

Slide 16 :

Infections Shingles Discitis Osteomyelitis Epidural abscess

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Metabolic Bone Disease Osteoporosis Osteomalacia Paget's disease

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Neoplasm Secondaries Myeloma , etc

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Red flags Spine fracture Cancer or Infection Cauda equina syndrome

Slide 20 :

Red flags for spine fracture Major trauma Minor trauma, or even just strenuous lifting, in people with osteoporosis Suspicion of secondaries

Slide 21 :

Rx –suspected spinal # X-ray Refer if #, if not follow up in 10 days On follow-up -if fracture still suspected, or -multiple sites of pain, consider bone scan and referral

Slide 22 :

Red flags for cancer or infection Age > 50 years and new back pain, or age <20 years History of cancer Constitutional symptoms (fever, unexplained wt. loss) Recent bacterial infection (e.g. UTI) IVDU Immune suppression Pain that worsens when supine; severe night-time pain; thoracic pain Structural deformity

Slide 23 :

Rx –suspected cancer or infection Check FBC,ESR, Urine analysis If still concerned, consider -referral - bone scan, X-ray, etc. Note that a negative X-ray alone does not rule out disease.

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Red flags for cauda equina syn. Perianal/perineal sensory loss (Saddle anaes.) Bladder dysfunction (e.g. urine retention, increased frequency, overflow incontinence) Faecal incontinence Neurological deficit in the lower extremities Unexpected laxity of the anal sphincter

Slide 25 :

Rx-suspected Cauda equina syn. Refer immediately

Slide 26 :

Yellow Flags Belief that pain and activity are harmful Sickness behaviours (extended rest) Social withdrawal Emotional problems Problems and/or dissatisfaction at work Problems with claims or compensation or time off work Overprotective family; Lack of support Inappropriate expectations of treatment

Slide 27 :

How do I know my patient has simple low back pain? Thorough history + brief examination Red & yellow flags Distinguish referred pain from nerve root pain Consider diagnostic imaging only if red flags

Slide 28 :

Chronicity Acute :< 6 weeks Sub-acute : 6-12 weeks Chronic >12 weeks

Slide 29 :

Complications Chronicity Depression Disability and loss of employment Cauda equina syndrome

Slide 30 :

Table 1. Questions for disability assessment.

Slide 31 :

Rx of Simple Low Back Pain Educational advice Symptom control Rapid return to usual activities (incl. work) Consider referral to -physiotherapists -osteopaths -chiropractors Address any psycho-social risk factors. Assess response to treatment after about 4 weeks.

Slide 32 :

Drug treatment Paracetamol – 1st choice If it is unsuitable/ineffective -NSAID s’ if suitable -Combination : e.g. paracetamol, an NSAID, or codeine Muscle relaxant (diazepam-1st choice)

Slide 33 :

Traction Electrotherapy Ultrasound Interferential therapy Laser treatments TENS - not to be confused with PENS Not recommended Rx

Slide 34 :

What do I do if it remains after 4-6 weeks? Reassess Address concerns Adjust analgesia to control pain -Pcm ,NSAIDs’ ,Diazepam , -Antidepressants, Gabapentin, Amitriptyline, Opioids

Slide 35 :

not responding to analgesia ? Referral Multi-disciplinary (bio-psycho-social) assessment Cognitive behavioural therapy Spinal manipulation therapy (SMT) Exercise therapy Back school

Slide 36 :

Evidence based medicine Routine physiotherapy was no more effective for chronic low back pain than one session of assessment and advice from a physiotherapist [Frost et al, ‘04]

Slide 37 :

Evidence …. Exercise and spinal manipulation therapy (SMT) provide at best only modest clinical benefits acupuncture is more effective than no treatment acupuncture compared with other active treatments is inconclusive.

Slide 38 :

Summary Red & Yellow flags Analgesia Disability Support

Slide 39 :

NICE Referral guidelines Cauda equina - immediately Serious spinal pathology – in 1 wk Progressive neurological deficit –in 1 wk Nerve root pain that is not resolving after 6 weeks –in 3 wks Inflammatory disorder -soon Yellow flags not resolved in 3 mon-soon

Slide 40 :

	Medslides_PPT 1 Years ago. Category: Internal Medicine

Tags:	Internal Medicine

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