Q. What are they?
A. Signs and symptoms that indicate serious spinal pathology
- Age > 55 (above this age, particularly above 65) the chances of being diagnosed with serious pathologies such as cancer increases
- PMHx or FHx of Ca
- Unexplained weight loss (5% within a 4 week period not related to change in diet or exercise)
- Constant / unremitting / progressive / non-mechanical pain (does not vary in a 24 hr period)
- Night pain (due to increase bony lysis at night)
- Generally unwell (fever / night sweats / signs of systemic illness)
- Bilateral neurological signs
- Ataxic gait (lack of muscle coordination / uncoordinated / jerky movements / poor balance) could indicate MS, stroke or TIA, head trauma, damage to cerebellum, spinal cord damage, brain tumour)
- Major trauma (fall from a height / RTA)
- Minor trauma (in osteoporotic patients)
- Thoracic pain (most common region for metastases)
- Long term use of steroids
Cauda Equina (require immediate referral to hospital for neurosurgical)
- Saddle anaesthesia (perianal sensory loss)
- Bladder or bowel dysfunction (urinary retention / incontinence or faecal incontinence)
- Bilateral leg pain / sciatica / neurological signs
Q. What are they?
A. Bio-psychosocial factors that may risk increase likelihood of chronicity
- Pending compensation claim
- Off word
- Low work status
- Inappropriate coping strategies
- Passive dependent locus of control
A - Attitudes
Towards the current problem. Does the patient feel that with appropriate help and management they will return to normal activities?
B - Beliefs
The most common misguided belief is that the patient feels they have something serious causing their problem-usually cancer. 'Faulty' beliefs can lead to .
C - Compensation
Is the patient awaiting payment for an accident/ injury at work/ RTA?
D - Diagnosis
or more importantly . Inappropriate communication can lead to patients misunderstanding what is meant, the most common examples being 'your disc has popped out' or 'your spine is crumbling'.
E - Emotions
Patients with other emotional difficulties such as ongoing depression and/or anxietous states are at a high risk of developing chronic pain.
F - Family
There tends to be two problems with families, either over bearing or under supportive.
W - Work
The worse the relationship, the more likely they are to develop chronic LBP.