MED SURG 206 EXAM 2 LATEST 2023-2024 ACTUAL EXAM QUESTIONS AND CORRECDETAILED ANSWERS |AGRADE
Low Back Pain
Generally, back pain due to musculoskeletal disorders is aggravated by
activity,whereas pain due to other conditions is not.
Pathophysiology
Vertebrae- rigid units
intervertebral discs- flexible
units
Obesity, postural problems, structural problems, and overstretching of the
spinalsupports may result in back pain
The lower lumbar discs, L4–5 and L5–S1, are subject to the greatest
mechanical stressand the greatest degenerative changes. A young
person’s discs are mainly fibrocartilage with a gelatinous matrix
Clinical Manifestations
acute back pain (lasting fewer than 3 months)
chronic back pain (3 months or longer without improvement) and fatigue
radiculopathy-pain radiating from a diseased spinal nerve root or
radiating down thelegs
sciatica- pain radiating from an inflamed sciatic nerve
paravertebral muscle spasm (greatly increased muscle tone of the back
posturalmuscles)
Assessment and Diagnostic Findings
The presence of bruising, older age and prolonged use of
glucocorticoid medicationsincreases the risk of a fracture
posttraumatic injury
The diagnostic procedures are contraindicated in suspected spinal
infection, severe neurologic weakness, urinary or fecal incontinence, and a
new onset of back pain in apatient with cancer
Diagnostic Procedures for Low Back Pain
X-ray of the spine: may demonstrate a fracture, dislocation, infection,
osteoarthritis,or scoliosis
Bone scan and blood studies: may disclose infections, tumors, and
bone marrowabnormalities
Computed tomography (CT) scan: useful in identifying underlying
problems, such asobscure soft tissue lesions adjacent to the vertebral
column and problems of vertebral discs
Magnetic resonance imaging (MRI) scan: permits visualization of
the nature andlocation of spinal pathology
Electromyogram (EMG) and nerve conduction studies: used to
evaluate spinalnerve root disorders (radiculopathies)
Myelogram: permits visualization of segments of the spinal cord that
may have herniated or may be compressed (infrequently performed;
indicated when MRI scanis contraindicated)
Ultrasound: useful in detecting tears in ligaments, muscles, tendons, and
soft tissuesin the back
Medical Management
Most back pain is self-limited and resolves within 4 to 6 weeks with
analgesics, rest,and avoidance of strain
Management focuses on relief of discomfort, activity modification, and
patienteducation
acute low back pain- nonsteroidal anti-inflammatory drugs (NSAIDs)
short-term prescription muscle relaxants (e.g.,
cyclobenzaprine[Flexeril])
chronic low back pain- Tricyclic antidepressants (e.g., amitriptyline [Elavil])
serotonin-norepinephrine reuptake inhibitors (e.g.,
duloxetine[Cymbalta])
radiculopathy pain – atypical anticonvulsant medications (e.g., gabapentin [NeurontinSystemic corticosteroids and acetaminophen (Tylenol) are not effective in
alleviating lowback pain
nonpharmacologic interventions
thermal applications (hot or cold)
spinal manipulation (e.g., chiropractic therapy)
Lumbar support belts are not recommended to treat acute low back pain but
effective inpreventing low back pain in occupational health settings