Acute and Chronic Low Back Pain (Sherpath)

Overactivity

A common cause of low back pain is muscle soreness from overactivity. Muscles and ligament fibers can be overstretched or injured. Usually resolves within a few days

A patient with low back pain relates working as a cashier at a local grocery store. Which item would the nurse teach the patient to keep nearby in the workplace to best assist with managing pain?

A footstool Use of a footstool will help the patient maintain a neutral pelvic position, which will alleviate the pain.

Scoliosis

Abnormal S curve of the spine that may develop in children, most often during their teenage years. May develop in older patients who have arthritis May cause back pain and possibly leg symptoms, if pressure on the nerves is involved

The nurse is developing a plan of care for a patient admitted to the hospital with chronic back pain. Which interventions should be included in the plan?

Assess patient's pain level The patient's pain level should be continually assessed and evaluated. Offer hot and cold compresses Application of heat and cold in the form of compresses can help with pain reduction. Provide pillows while the patient is sleeping Pillows can provide lumbar support and promote proper pelvic positioning while the patient is sleeping.

The nurse walks into the room of a patient with low back pain. The patient is packing belongings and preparing for discharge. The nurse notes the patient is leaning forward with the legs straight, picking up shoes off the floor. Which action should the nurse take?

Correct the patient by reminding him or her to bend the knees when leaning forward. Rationale: Bending the knees when leaning forward is the correct and safe way to bend to retrieve items off the floor or ground.

Laminectomy

Creates space by removing the lamina, the back part of the vertebra that covers the spinal canal. Enlarges the spinal canal to relieve pressure on the spinal cord or nerves.

Nursing Assessment

History of back strain or trauma Medication use Previous back surgeries or other procedures Health history including smoking Activity level Elimination Details of work duties The nurse will assess range of motion, presence of guarding, and reflex responses and will palpate leg muscles and perform straight leg tests.

Radiofrequency discal nucleoplasty

Instead of using a heating wire (as in IDET), a special radiofrequency probe is inserted through the needle into the disc. This probe generates a highly focused plasma field to break up the molecular bonds of the gel in the nucleus, essentially vaporizing some of the nucleus. The result is that 10% to 20% of the nucleus is removed. This decompresses the disc and reduces the pressure on both the disc and the surrounding nerve roots.

Lifestyle recommendations

Maintain a healthy weight Exercise (low impact) regularly Use hot/cold compresses for relief of pain

Causes of low back pain are outlined.

Overactivity Disc injury Degenerative disc disease (DDD) Spinal stenosis Scoliosis

The student nurse asks the instructor, "Why are nurses at such great risk for developing low back pain?" Which response by the instructor is correct?

"Nurses often perform a lot of heavy lifting and bending." Rationale: The physical activities involved in patient care include lifting, turning, and bending. All of these activities can increase the risk for low back pain.

During a triage assessment, the nurse notices that a patient with low back pain is sobbing softly. Based on this observation, which would be an appropriate response?

"You are crying. Do you want to talk about how you're feeling?"

The nurse is caring for a patient with unrelieved chronic pain. The patient becomes very tearful and says, "No amount of physical therapy or drugs has worked. I'll never get relief!" Which is an appropriate response by the nurse?

"You seem very upset. Would you like to talk to your provider about surgical options?"

A patient recently diagnosed with chronic low back pain tells the clinic nurse that she has added spinning classes to her exercise routine of step aerobics and weight training. The patient asks the nurse for any suggestions about other workouts to add. Which response should the nurse give to the patient?

"You should discuss your routine with your health care provider." Rationale: Excessive exercise beyond the health care provider's recommendation is not advised. The nurse is correct in recommending that the patient discuss this routine with her health care provider

A patient with low back pain is beginning chiropractic therapy. The provider prescribes cyclobenzaprine, 10 mg every eight hours as needed, for muscle stiffness or pain. The medication is available in 5-mg tablets. The patient asks the nurse, "How many of these pills can I take each day?" __

6 Every eight hours equals three times per day (24/8 = 3). The order is for 10 mg every eight hours; 10 mg 3 = 30 mg in 24 hours. The medication is available in 5-mg tablets. 30 mg/ 5-mg tablets = six tablets in 24 hours.

Which patient does the nurse identify as having the greatest risk for developing low back pain?

A 30-year-old patient with a body mass index (BMI) 10% above recommended value Rationale: Being overweight is a risk factor for low back pain, and this patient has a BMI 10% above the recommended valu

A patient arrives at the emergency department stating that he twisted his back while playing football and is having "really bad pain." Which order does the nurse anticipate will be given initally for the patient?

Administer ibuprofen for pain Rationale: Administration of a nonsteroidal anti-inflammatory drug, such as ibuprofen, is an appropriate initial pain relief measure for acute pain.

Risks for low back pain include:

Being overweight Poor muscle tone Stress Poor posture Smoking History of spinal problems Pregnancy

A patient reports nonradiating pain in the buttocks and numbness and tingling in the toes. The patient tells the nurse that the symptoms have been getting worse over the last few months, but the patient cannot remember what triggered it. The nurse suspects the patient may be experiencing which type of low back pain?

Chronic back pain Rationale: Chronic low back pain lasts more than three months, and the exact cause can be difficult to pinpoint.

Chronic Pain

Daily NSAIDs. An antidepressant (e.g., duloxetine) may help with sleep. An anticonvulsant (e.g., gabapentin) may help improve walking and relieve leg discomfort. Weight reduction Rest periods incorporated throughout the day Physical therapy Complementary therapies (such as acupuncture and yoga) Epidural corticosteroids or implanted devices that deliver pain medication may be prescribed for patients if initial therapeutic methods fail. Referral to surgery if the patient is not able to gain relief from any nonoperative treatments (conservative therapy).

A patient with chronic back pain tells the nurse, "I'd like to try more natural methods to control my pain. I'd rather not take any medications." Which information should the nurse provide the patient?

Details on a local acupuncture studio Rationale: Complementary therapy would not include use of medications and can be effective in treating pain

The patient with acute low back pain tells that nurse that a new job requires stocking shelves with boxes of equipment. Which information about proper body mechanics should the nurse give the patient?

Do not lift boxes past the elbows." This is the correct lifting technique that should be followed by the patient to maintain safety.

A patient with chronic low back pain is complaining of difficulty sleeping. Which medication would be an appropriate treatment for the patient's complaint?

Duloxetine Duloxetine, an antidepressant, will assist with promoting sleep.

Interspinous process decompression (IPD)

Involves an implant (called a spacer) made from titanium alloy. The implant (spacer) is inserted between spinous processes. This creates more space for the spinal cord and nerves in the spinal canal without removal of any bone.

Intradiscal electrothermoplasty (IDET)

Involves the insertion of a needle into the damaged disc with the guidance of an x-ray machine A special wire is then threaded down through the needle and into the disc. The wire is heated to destroy the small nerve fibers that have grown into the cracks of the disc. The heat also partially melts the annulus fibrosus, which triggers the body to generate new proteins to strengthen the disc.

Actions to avoid include:

Leaning forward without bending the knees Lifting above the level of the elbows Prolonged standing Sleeping with legs straight, instead of bent Exercising without consulting the health care provider if pain is severe Excessive exercise, beyond what is recommended Smoking or using tobacco products

Low back pain can be described as:

Localized: discomfort in one specific area Diffuse: pain in a larger area, generating from deep tissue Radicular: radiating along a nerve (e.g., sciatica) Referred: pain felt in the lower back but source is elsewhere (e.g., kidneys or lower abdomen)

Body mechanics recommendations

Maintain a neutral pelvic position; rest one foot on a stool if standing for a long period Ensure seats have good back support; use a pillow at the lumbar spine to maintain curvature Sleep in a side-lying position with a pillow between your legs If you are sleeping on your back, put a pillow under your knees. Use proper body mechanics (bending, lifting, turning) Use a firm mattress Wear flat or low-heeled shoes with shock-absorbing soles

Acute Pain

Non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants Severe pain may require use of corticosteroids or opioids. Massage, acupuncture, and hot and cold compresses Patients should rest for one to two days (but avoid prolonged rest) Patients should refrain from lifting, bending, twisting, and sitting too long.

spinal stenosis tx

Occurs when the space around the spinal cord narrows and puts pressure on the cord and spinal nerves. When intervertebral discs collapse and osteoarthritis (OA) develops, the body may respond by growing new bone in facet joints to help support the vertebrae. This bone overgrowth (spurs) can lead to a narrowing of the spinal canal. OA can also cause the ligaments that connect vertebrae to thicken, which can narrow the spinal canal.

A patient asks the nurse about the causes of low back pain. Which statement correctly describes the most common cause of low back pain?

Overactivity of the lower back muscles causes pain and soreness. Rationale: Overactivity is the most common cause of low back pain. Muscles and ligament fibers can be overstretched or injured during overactivity.

The nurse is caring for a patient with acute low back pain. Which topics would be included when teaching the patient about management techniques?

Safe use of oral opioid medications Safe, recommended use of opioid analgesics is effective in managing pain. Attending physical therapy sessions. Physical therapy can help the patient manage pain and develop techniques to prevent further episodes. Information on complementary therapy Complementary therapy, such as acupuncture, is effective in managing pain.

Disc injury

Small tears to the annulus sometimes occur with aging. Some individuals with disc tears have no pain at all. Others can have pain that lasts for weeks, months, or even longer. A small number of individuals may have constant pain that lasts for years and is quite disabling. A herniated disc is a common type of disc injury.

Diagnostic studies are very limited in evaluation of acute back pain but may be useful for chronic back pain.

Straight leg raising test: Definitive diagnostic abnormalities are present with nerve irritation and muscle strain. X-rays, magnetic resonance imaging (MRI), or computed tomography (CT) scans: Generally not done unless trauma or disease (cancer, spinal infection) is suspected. Electromyography (EMG): Used to assess the health of muscles and the nerve cells that control them. Myelogram: Uses contrast dye and x-ray to assess for problems in the spinal canal, including the spinal cord, nerve roots, and other tissues

Discectomy

Tends to be done as microdiscectomy, in which a special microscope is used to view the disc and nerves. This larger view allows the surgeon to use a smaller incision, which causes less damage to surrounding tissue. Before the disc material is removed, a small piece of the lamina from the affected vertebra may be removed (laminotomy).

Which findings would the nurse expect to note when assessing the lower extremities of a patient with low back pain?

Tense muscle tone Tense, firm muscles that do not relax easily are an expected objective finding in a patient with low back pain. Hyperactive reflexes Exaggerated reflexes are an expected objective finding in a patient with low back pain. Guarding of the area Guarding or protecting the painful area is an expected objective finding in a patient with low back pain.

Degenerative disc disease (DDD)

With age, intervertebral discs begin to wear away and shrink. They may collapse completely and cause the facet joints in the vertebrae to rub against one another. Pain and stiffness result

Disc replacement

Worn or damaged disc material between the vertebrae is removed and replaced with a synthetic or "artificial" disc. The goal of the procedure is to relieve back pain while maintaining motion that is more normal than would be allowed with some other procedures, such as spinal fusion.

The goal of nursing management

is to prevent an episode of acute low back pain and successfully manage chronic back pain

Chronic low back pain

lasts more than three months or involves a repeated incapacitating episode.

Acute low back

pain lasts four weeks or less

The nurse is reviewing the intake forms for a patient with acute low back pain. Which finding is most likely related to the cause of the pain?

twisted funny while playing volleyball Acute pain has a sudden onset most likely secondary to an injury, such as that sustained while participating in sports.