back pain

1. Community pharmacy
Rutter

2. lower back pain
Classifications
Importance
Causes
Diagnosis
Treatment

4. Why back pain is important
 Common case
 Quality of life
 Quality of work carried out when suffering pain

5. Causes of low back pain
Simple back pain :( not clear cause )
95% of cases , Over 90 % of patients will get better within 6 weeks
Spondylitis:
Pain is worse at rest but improves with physical activity.
Sciatica:
pain radiates to the leg
Others: (Malignancy , osteomyelitis , pyelonephritis , etc )

6. (Sciatica)

7. Diagnosis
Specific questions to ask the patient
age
Pain that radiates into the
buttocks implies nerve root
compression ( Sciatica )
patient must be referred
location
children under 15 : refer all
( spondylolysis , malignancy )
Older than 50 : refer all
(osteoporosis and malignancy )

8. Diagnosis
Onset Restriction of movement
Specific questions to ask the patient
 pain lasts longer than 6 weeks
patient must be referred
acute low back pain in the
elderly should be referred
Mechanical causes of pain is
relieved by rest
Systemic causes of back pain
are usually worse with rest
Weakness or numbness
 Progressive muscle weakness must be referred

9. Treatment
Analgesics {paracetamol, aspirin, NSAIDs}
paracetamol may be the best first-line choice for most people
Studies found that NSAIDs were no better than paracetamol for LBP
Compenation analgesics {paracetamol/codeine }
OTC doses of codeine are too low to produce significant
reductions in pain compared to single agents

10. Treatment
Antihistamines (doxylamine) and Caffeine
They are available in combination with paracetamol to
enhance the analgesic efficacy
Topical NSAIDs
Topical NSAIDs can provide good pain relief in acute musculoskeletal
conditions, without the adverse events seen with oral NSAIDs

11. Thank you