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LowerBackPain
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> 8in10 people get lower back pain at some stage Non specific 19 out of 20 acute onset LBP is non specific Nerve root pain (Sciatica) less than 1 in 20 acute pain 9 of 10 are prolapsed disc Cauda Equina emergency - rare lower back pain, weakness in one or both legs, numbness saddle, problems bladder / bowel (usually urine retention) Arthritis OA - more common - older RA - usually other joints affected Ank Spond - younger, pain and stiffness Rarely - other tumor / lesion / infection / bone disorder Non-specific pain ? sprain (stretched muscle /ligament), minor disc, facet joint - very hard to prove one or other as no test good may have obvious cause, may not may be mild or severe usually in one place but may spread relieved by lying, exacerbated by activity / coughing usually resolves within a week but may recur, if continues for several months - chronic Red flag gradual onset pain that is getting worse esp if constant and unrelieved by rest numbness / weakness pain that is upper back / lower thoracic steroids stiffness - esp if relieved by activity - ank spond bowel / bladder Sx - cauda equina post Hx trauma esp RTA over 50 / under 20 / aches at night / cancer elsewhere / HIV / drugs / wt loss / night sweats - ca / infection Usually no tests Mx Exersize - graded and within pain limits - get back to work asap, continue to avoid ongoing problems Pain control - PCM, NSAID, ?codeine, ??diazepam to muscle relax if very severe ?hot baths review 4-6 weeks if persistent Chronic more than 6/52, usually intermittent, variable mild and severe Mx - same as acute then ... Amitriptiline Physio, massage, acupuncture CBT pain clinic ??? spinal fusion
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