EPIDEMILOGY
What is the second most common reason for physician outpatient visits?
Low Back Pain!!
What are the basic history questions you need to ask regarding pain?
•Onset of pain, Location of pain, Duration: timing of pain, Character: sharp, dull, scale of 0–10, Aggravating factors, Relieving factors
Full exam on initial evaluation, Neurologic evaluation on initial evaluation
•Inspection (skin/posture), Palpation, Active Range of motion (flexion, extension, lateral flexion, axial rotation), Gait and Mobility, Bilateral neural tension test (straight leg raise test), FABER test
What percentage of the population will present with low back pain at some point in their life?
Besides the nature of the pain, what other historical information do you need to gather from a patient with low back pain?
•Treatments attempted, Medical and social history, Consider “Red flags” and “Yellow flags," Functional pain scale (PEG scale)
What is important on neuro exam for low back pain?
•Gait Analysis, Heel Walking, Toe Walking
•Strength of Lower Extremities
•Reflexes of Lower Extremities
•Sensation of Lower Extremities
Which percentage of patients with low back pain recover? Which go on to develop chronic pain?
95% recover
5% develop chronic pain
What questions are on the PEG SCALE?
1) What number best describes your pain on average in the past week?
2)What number best describes how, during the past week, pain has interfered with your enjoyment of life?
3)What number best describes how, during the past week, pain has interfered with your general activity?
What is the nerve root, reflex, muscle, and sensation that matches the following discs:
1) L3-L4
2) L4-L5
3) L5-S1
1) L3-L4-->Root L4, Reflex patella, Muscle anterior tibialis, Sensation Medial leg and medial foot
2) L4-L5-->Root L5, Reflex n/a, Muscle extensort halucis, Sensation lateral leg and dorsum of foot
3) L5-S1-->Root S1, Reflex achilles, Muscle personeus longus and brevis, lsensation lateral foot
What was the total cost for low back pain in the US in 2006?
100-200 billion dollars
What are the red flag findings on history for low back pain?
•Age <20 or >50, Severe or progressive neurologic deficit, Bladder/bowel dysfunction, History of cancer, Fever or unexplained weight loss, Disturbed gait and saddle anesthesia
What percentage of the US population reports low back pain lasting at least 1 day in the last 3 months?
25%
What are the "yellow flag" history findings for low back pain?
Affect: anxiety; depression; feeling of uselessness, Behavior: adverse coping strategies, Beliefs: thinks pain is “the worst” and must be eliminated before returning to activity, Social: history of abuse; lack of support, Work: expectation that pain will increase with work