{"id":411,"date":"2017-03-26T14:07:09","date_gmt":"2017-03-26T14:07:09","guid":{"rendered":"http:\/\/papergp.com\/index.php\/rheumatology-and-musculoskeletal\/back-pain\/"},"modified":"2023-01-24T11:25:26","modified_gmt":"2023-01-24T11:25:26","slug":"back-pain","status":"publish","type":"page","link":"https:\/\/papergp.com\/index.php\/rheumatology-and-musculoskeletal\/back-pain\/","title":{"rendered":"Back pain"},"content":{"rendered":"<div class=\"content-box-blue\">\n<h4>Differential diagnosis<\/h4>\n<ul>\n<li>Cauda equina\n<ul>\n<li>Urinary incontinence\/retention<\/li>\n<li>Faecal incontinence<\/li>\n<li>Saddle anaesthesia<\/li>\n<\/ul>\n<\/li>\n<li>&nbsp;Malignancy\n<ul>\n<li>Previous cancer, weight loss, thoracic<\/li>\n<\/ul>\n<\/li>\n<li>Infection\n<ul>\n<li>Fever, immunosuppression, IV drug use<\/li>\n<\/ul>\n<\/li>\n<li>Myeloma\n<ul>\n<li>Lethargy, infection, bleeding<\/li>\n<\/ul>\n<\/li>\n<li>Vertebral fracture\n<ul>\n<li>Trauma, steroids, osteoporosis<\/li>\n<\/ul>\n<\/li>\n<li>AS, RA\n<ul>\n<li>Morning stiffness<\/li>\n<\/ul>\n<\/li>\n<li>Non specific<\/li>\n<\/ul>\n<\/div>\n<hr>\n<div class=\"content-box-blue\">\n<h4>Data gathering<\/h4>\n<ul>\n<li>Red flags\n<ul>\n<li>as above<\/li>\n<li>age &lt;20, &gt;50<\/li>\n<li>progressive<\/li>\n<li>lying down doesn&#8217;t help<\/li>\n<\/ul>\n<\/li>\n<li>Examine\n<ul>\n<li>look, feel, move &#8211; back movements, straight leg raise, gait<\/li>\n<li>neurological &#8211; sensation, reflexes, peripheral pulses<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<hr>\n<div class=\"content-box-blue\">\n<h4>Clinical management (non specific low back pain)<\/h4>\n<ul>\n<li>Investigations (usually none needed but if persistent\/atypical):\n<ul>\n<li>Bloods\n<ul>\n<li>FBC, U+E, LFTs, Ca, ESR, Serum protein electrophoresis<\/li>\n<\/ul>\n<\/li>\n<li>Urine BJP<\/li>\n<li>Xray<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Treatment\n<ul>\n<li>Lifestyle &#8211; lifting technique<\/li>\n<li>Back exercises &#8211; knee to chest, pelvic thrust, knees side to side<\/li>\n<li>Analgesia<\/li>\n<li>Others: diazepam, tramadol, acupuncture, CBT, pain clinic<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Follow-up \/ Safety-net\n<ul>\n<li>Non-specific low back pain &#8211; &gt;6week &#8211; refer for structured exercise programme, manual therapy<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<hr>\n<div class=\"content-box-blue\">\n<h4>Reference<\/h4>\n<p><a href=\"https:\/\/www.valeofyorkccg.nhs.uk\/rss\/data\/uploads\/msk\/acute-back-pain-pathway-version-15-pathway.pdf\">Vale of York CCG acute low back pain pathway<\/a><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Differential diagnosis Cauda equina Urinary incontinence\/retention Faecal incontinence Saddle anaesthesia &nbsp;Malignancy Previous cancer, weight loss, thoracic Infection Fever, immunosuppression, IV drug use Myeloma Lethargy, infection, bleeding Vertebral fracture Trauma, steroids, osteoporosis AS, RA Morning stiffness Non specific Data gathering Red flags as above age &lt;20, &gt;50 progressive lying down doesn&#8217;t help Examine look, feel, move &hellip; <a href=\"https:\/\/papergp.com\/index.php\/rheumatology-and-musculoskeletal\/back-pain\/\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">Back pain<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":408,"menu_order":166,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-411","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/411","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/comments?post=411"}],"version-history":[{"count":15,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/411\/revisions"}],"predecessor-version":[{"id":2327,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/411\/revisions\/2327"}],"up":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/408"}],"wp:attachment":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/media?parent=411"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}