476222
45 y.o. M,
acute LBP after
heay lifting
- pt cannot straighten up
- point tenderness over his lumber spine
- Numbness
- over left anterior thigh & leg
- extends to the medial aspect of left foot & great toe
- extends to the medial aspect of left foot & great toe
- motor testing finds weakness in knee extension
- diminished patellar reflex
- positive straight leg raise on the left
- positive straight leg raise on the left
- diminished patellar reflex
- over left anterior thigh & leg
- Numbness
- point tenderness over his lumber spine
- acute pain
is a
protective
measure
of the
body
- sudden
and
typically
goes away
after the
pain
stimulus is
removed &
tissue heals.
Chronic
pain is long
term
- Symptoms: anxiety,
tachycardia,
hypertension, fever,
diaphoresis, dilated
pupils, moaning,
touching, rocking,
elevated blood
sugar, decrease in
gastric acid
secretion &
intestinal motility,
decrease in blood
flow to the viscera
and skin, and
nausea
(occasionally)
- Treatment: rest for at least a
week, hot and/or cold packs,
calcium with vitamin D to
strengthen, physical therapy,
massage, aquatics, weight
bearing activities eventually,
steroids to decrease
inflammation, an NSAID like
ibuprofen (careful
consideration is necessary
for cardiac patients) and
opioids like oxycodone or
codeine (unless the patient
has a history of opioid
abuse); PCP and pain
management work together.
Follow up is necessary to
determine what works.
Surgery is a last resort
- H &H to determine
hemodynamic instability,
amylase & lipase levels to
r/o pancreatic injury or
disease, urinalysis to r/o
kidney injury or disease
(UTI) serum calcium level
to r/o hypercalcemia,
SMA if cancer considered
- H &H to determine
hemodynamic instability,
amylase & lipase levels to
r/o pancreatic injury or
disease, urinalysis to r/o
kidney injury or disease
(UTI) serum calcium level
to r/o hypercalcemia,
SMA if cancer considered
- Treatment: rest for at least a
week, hot and/or cold packs,
calcium with vitamin D to
strengthen, physical therapy,
massage, aquatics, weight
bearing activities eventually,
steroids to decrease
inflammation, an NSAID like
ibuprofen (careful
consideration is necessary
for cardiac patients) and
opioids like oxycodone or
codeine (unless the patient
has a history of opioid
abuse); PCP and pain
management work together.
Follow up is necessary to
determine what works.
Surgery is a last resort
- Symptoms: anxiety,
tachycardia,
hypertension, fever,
diaphoresis, dilated
pupils, moaning,
touching, rocking,
elevated blood
sugar, decrease in
gastric acid
secretion &
intestinal motility,
decrease in blood
flow to the viscera
and skin, and
nausea
(occasionally)
- acute pain
comes
from
cutaneous
and deep
somatic
tissue or
visceral
organs;
classified
as acute
somatic,
acute
visceral ,
or referred
- red flags: age, how
long the patient has
had the symptoms,
atypical pain
complaints, injury or
illness, medications
used, frequency and
duration of pain,
whether or not
incontinence of bowel
or bladder is present,
genetic conditions,
herniation, fractures,
tumors,and infection
- acute
pain lasts
less than
6 weeks,
subacute
pain
persists 6
to 12
weeks,
chronic
pain
persists
for more
than 12
weeks
- Pain is
transmitted as
an impulse
from the site of
injury to the
brain. The
peripheral
nerve fibers
tell the spinal
cord there in
pain. Next, the
dorsal horn
processes the
transmission.
Finally, the
pain signal
reaches the
thalamus and
cerebral
cortex.
Unrelieved
pain can
cause physical
and/or
psychologic
problems
- red flags: age, how
long the patient has
had the symptoms,
atypical pain
complaints, injury or
illness, medications
used, frequency and
duration of pain,
whether or not
incontinence of bowel
or bladder is present,
genetic conditions,
herniation, fractures,
tumors,and infection
- sudden
and
typically
goes away
after the
pain
stimulus is
removed &
tissue heals.
Chronic
pain is long
term
- symptoms at
presentation of
patient:
- most likely a cervical
fracture: cannot
straighten up,
tenderness over lumbar
spine, diminished
patellar reflex
- monitor for spinal shock
- monitor for spinal shock
- possible cauda equina:
tenderness over lumbar
spine, weakness in knee
extension, positive straight
leg raise
- most likely a cervical
fracture: cannot
straighten up,
tenderness over lumbar
spine, diminished
patellar reflex
- diagnosis: acute injury requires X-ray
(centeroposterior& lateral films of
lumbar spine. MRI to r/o lesions,
CT to r/o bony spurs
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