Term
| What are common hallmarks of LBP? |
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Definition
Affects sacral or lumbar area
Worsens during the day or night
Common causes - spasms/degeneration
Age 30-50, mostly women. Obesity a major factor. |
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Term
| When should a patient be referred for LBP? |
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Definition
Pain worsens at night
Radiating pain
Old or young
Chronic pain for 3-6 months |
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Term
| What is non drug therapy for LBP? |
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Definition
short term or NO bed rest.
Alternating cold and heat therapy - 20 minutes. Do not use heat if there is swelling!
Massage, acupuncture, chiropractic, physical therapy
Low impact exercise - yoga |
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Term
| What are the 3 groups of lower back pain? |
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Definition
- nonspecific LBP, muscular in origin
- Spinal stenosis
- Specific cause such as a tumor, fracture |
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Term
| What is the drug of choice for acute pain? |
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Definition
Acetaminophen
- Spasms - BZD or muscle relaxants
- LBP: NSAID or APAP. Opioids and tramadol 2nd/3rd line. Use Naproxen |
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Term
| What are the cautions when prescribing NSAIDs? |
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Definition
- Advanced age
- Diabetes, Heart failure, HTN
- Impaired renal function
- Pregnancy
- CVD or recent CABG
- Sulfa allergy in Celebrex. |
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Term
| What are ADR's and interactions for Chlorzoxazone? |
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Definition
- Hepatotoxicity
- Hypersensitivity
- Urine discoloration |
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Term
| What are ADR's and interactions for Flexeril? |
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Definition
- Interactions and AEs similar to TCAs
- More frequent dry mouth, less frequent dizziness than Soma.
- Related to amitriptyline. Lower dose as effective as higher dose. Avoid in hepatic impairment. |
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Term
| What are ADR's and interactions for diazepam? |
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Definition
Neuronal inhibition through GABA receptors
Has abuse potential. Use a lower dose in the elderly. |
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Term
| What are ADR's and interactions for Skelaxin? |
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Definition
Low drowsiness and cognitive risks. Paradoxical muscle cramps. May cause withdrawal.
- Avoid in serious liver and renal impairment
- Test liver function regularly |
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Term
| What are ADR's and interactions for Robaxin? |
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Definition
May discolor urine
Less drowsiness than Flexeril
IV/IM available. |
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Term
| What are ADR's and interactions for Zanaflex? |
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Definition
Stimulates alpha-2 receptors, related to clonidine.
Decreases BP, can cause hypotension
Can cause hepatotoxicity
Hallucinations. Cipro/Luvox increases levels, contraindicated.
Avoid with 1A2 inhibitors - Cimetidine, oral contraceptives
- caution with QT prolonging drugs.
- Short acting, food affects, monitor liver function |
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Term
| When should skeletal muscle relaxants be used? |
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Definition
short term relief when APAP and NSAIDs not effective
Interrupts spasm-pain-spasm cycle
Depression of CNS.
CNS depressants: Soma, Parafon Forte, Robaxin, Skelaxin
Antihistamine-like: Norflex
Gaba-agonist: Valium
TCA-like: Flexeril
Alpha agonist: Zanaflex |
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Term
| What Txs are used for chronic back pain? |
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Definition
- APAP or NSAIDs
- 2-3 days rest
- Continuous heat
- Epidural steroids
- Physical therapy
- Opioids, tramadol, BNZ
- Low dose TCA, lidocaine patch, Neurontin or Topamax, Cymbalta. |
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Term
| How does Cymbalta works for LBP? |
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Definition
As well as being an SNRI, has analgesic effects. Inhibits pain pathways in CNS, can see a 30% reduction.
- Start at 30 mg and titrate up, take w/ food. Can cause dry mouth and sleepyness, sweating. |
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Term
| What is special about lidocaine patches? |
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Definition
Can apply 3 patches in 12 hours
Can cut these patches, unlike others
Little systemic effect. |
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Term
| What are the major side effects of Topamax? |
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Definition
ocular side effects within first 2 weeks.
Also numbness, fatigue, impaired memory and concentration |
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Term
| What natural supplements are available for LBP? |
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Definition
- alpha-lipoic acid - increases neuronal blood flow and improves conduction velocity. Decreases neuropathic pain symptoms
- Acetyl-L-carnitine - slows neuronal degredation and decreases excessive firing |
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Term
| What are common spinal disorders? |
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Definition
- Herniated disc, degeneration - in cervical or lumbar
- Whiplash - hyperextension of the neck. Atlas, axis, C3, C7
- Scoliosis - S spine. uneven shoulders and hips
- Sciatica - largest nerve in the body. Caused by lumbar herniated disc. Piriformis syndrome
- Injury, strain, sprain
- Pinched nerve - by herniated disc or bone spur |
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