A Four Letter Word BACK PAIN Bianca Moses Spring 2013.

A Four Letter Word

BACK PAIN

Bianca Moses Spring 2013

SPINAL ANATOMY

SPINAL ANATOMY

Verte

bra

SPINAL ANATOMY

LumbarSpine

Verte

bra

SPINAL ANATOMY

LumbarSpine

Spinal Cord

Verte

bra

SPINAL ANATOMY

LumbarSpine

Nerve RootSpinal Cord

Verte

bra

SPINAL ANATOMY

LumbarSpine


Lum

bar D

isc

Verte

bra

SPINAL ANATOMY

LumbarSpine


Lum

bar D

isc

Nucleus

Verte

bra

SPINAL ANATOMY

LumbarSpine


Lum

bar D

isc

Nucleus

Annula

Verte

bra

ANATOMY OF MOVEMENT

ANATOMY OF INFLAMMATION


Disc itself can cause pain“Discogenic pain”



Most pain comes from inflammationwhich puts pressure on spinal cord thus transmitting pain down nerves




Enough pressure on spinal cord causesno signal transmission down spinal

cord and results in numbness






X






Where you feel pain or lack thereof, depends on the location of the injury

X

ANATOMY OF DERMATOMES





S1



L5



L4



L3



S1, S2



L4, L5



L3, L4

RESULT ON VERTEBRAE

RESULT ON VERTEBRAE

Nerve Root Impingement

RESULT ON VERTEBRAE

Osteoarthritis

RESULT ON VERTEBRAE

WHAT CAN A NURSE DO?

WHAT CAN A NURSE DO?• Teach proper body mechanics


25 lbs of force on spinal disc

• Teach proper body mechanics




???? lbs of force on spinal disc




• Weight loss





• Weight loss


Every extra pound of body weight

Adds 5-10 lbs of pressure on your spine




• Weight loss

• Low impact exercise


Every extra pound of body weight

Adds 5-10 lbs of pressure on your spine


• Weight loss




• Weight loss


• Shoe selection


• Weight loss


• Shoe selection

• Ergonomics


• Weight loss


• Shoe selection

• Ergonomics

• Sleep on side with knees flexed and a pillow between knees


• Weight loss


• Shoe selection

• Ergonomics


• Sleep on back with roll under knees to flex hips


• Weight loss


• Shoe selection

• Ergonomics



• Teach avoidance of pro-inflammatory foods

SugarOilsTrans FatsDairyGrain Fed MeatsRed Meat/Processed meatRefined GrainsMSG


• Weight loss


• Shoe selection

• Ergonomics




• Cold (acute) or Heat (after 24 hrs)


• Weight loss


• Shoe selection

• Ergonomics




• Cold (acute) or Heat (after 24 hrs)

• Med Teaching

PATIENT: SUBJECTIVE INFO


• “Woken up at 3am by the pain”



• “Excruciating pain in lower back”


• “I can’t move bit without

in any direction, even a little horrible pain”





• “I can’t bend I can’t lie


or move at all…I can’t sit, I down, I can’t do anything”





• “I can’t bend I can’t lie


or move at all…I can’t sit, I down, I can’t do anything”



• “When lifting a bucket of ice at work yesterday, I had a feeling of ‘release’ in my lower back, but it didn’t hurt, it just felt weird, like a ‘give’”

PATIENT: OBJECTIVE INFO


• Physically fit 20 yo female, BMI 22, no previous health Hx



• Seeking attention at urgent care clinic


• Employed as a waitress; full time student







• Pt reports a possible trauma at work when lifting a bucket of ice from the floor, but no immediate pain was felt






• Patient is painful to the point of tears and cannot achieve relief from Sx of pain and can barely walk







• Pain is 9/10 out of 10








• Movement is guarded, limited range of motion









• Depressed achilles reflex









• Depressed achilles reflex, positive patellar tendon reflex










• Straight leg raise (+)










• Straight leg raise (+), crossover straight leg (+)










• Straight leg raise (+), crossover straight leg (+), trendellenburg test (+)











(-) (+)Not Good

SAME PATIENT, 10 YRS LATER: SUBJECTIVE INFO

• “I have a difficult time getting comfortable in bed”



• “Sitting, standing or laying in the same position for longer than a few minutes causes pain”


• “When its bad, sitting is just

sneezing, coughing or just lifting a foot while sitting causes too much pain to bear”





• “Ibuprofen will bad, it can’t even




touch the pain. The pain is always there.”


sometimes help, but when the pain is really







• “My leg gets hot spots that burn or intense itching that can’t be soothed or scratched”










• “Some parts of my leg or butt cheek go numb or feel like static on TV” Patient is uninsured”










• “Some parts of my leg or butt cheek go numb or feel like static on TV” Patient is uninsured”

• “Sometimes if feels like a knitting needle being pushed through my heel”



SAME PATIENT, 10 YRS LATER: OBJECTIVE INFO

• 30yo female, BMI 22, moderately active



• Patient is frequently uncomfortable, but has self treated with massage, NSAIDS and modified lifestyle around back pain




• Hx of chronic lumbar back pain, foot pain, muscle spasms





• Reports trauma from 10 years ago and frequently “throws back out”






• Significant weakness in right leg AEB falls to right when walking on toes or heels







• Full time employment with no physical demands








• Pain is currently 3/10 or 4/10, but during flare ups pain is 8/10


POSSIBLE NURSING DIAGNOSES

• Acute pain r/t physical injury

• Chronic pain r/t central or peripheral nerve injury

• Impaired walking related to musculoskeletal impairment

• Ineffective role performance related to physical symptoms of pain

• Bathing self care deficit r/t musculoskeletal impairment

• Dressing self care deficit r/t musculoskeletal impairment

• Deficient knowledge r/t lack of exposure

• Impaired physical mobility r/t musculoskeletal impairment

• Fear r/t innate origins of acute pain

• Risk for falls r/t: difficulty with gait, impaired balance, impaired physical mobility

• Impaired comfort r/t to acute pain

References

Campbell, T., & Campbell, T. (2005). The china study: Startling implications for diet, weight loss and long-term health. Dallas, TX: BenBella Books.

Care for your back and it will love you back. (2013). AlbertaRN, 68(4), 26-27.

Copstead, L., & Banasik, J. (2005). Pathophysiology. (3 ed, Vol. 465-470). Stlouis, Missouri: Elsevier Mosby.

Eisenberg D., Buring, J., Hrbek, A, Davis, R., Connelly, M., Cherkin, S., Levy, D., & Cuningham, M. (2012). A model of integrative care for low-back pain. The Journal of Alternative and complementary Medicine, 18(4), 354-362.

Fulkerson, L. (Director) (2011). Forks over knives [Web].

Lewis, S., Dirksen, S., Heitkemper, M., Bucher, L., & Camera, I. (2011). Medical surgical nursing assessment and management of clinical problems. (8th ed.). Philadelphia, Pennsylvania: Elsevier Mosby.

Walker, J. (2012). Back pain: Pathogenesis, diagnosis and management. Nursing Standard, 27(14), 49-56.

A Four Letter Word BACK PAIN Bianca Moses Spring 2013.

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