Low Back Pain Pre-Test

1. With regards to the impact of low back pain, tick which of the following statements are true: 

a. If an individual has been off sick with back pain for 1 month, there is a 20% chance of them still being off work one year later  

b. If an individual has been off sick with back pain for 6 months, there is a 10% chance of them being off work one year later  

c. Low back pain is estimated to affect at least 60% to 80% of the population at some time in their lives and most of these patients will have resolution of their back pain with simple measures including simple analgesia, manipulation and exercise advice  

2. What is the repeat consultation rate after 3 month following the initial consultation for an acute episode of low back pain? Please tick which answer is true. 

a. Less than 10%  
b. 11 – 28%  
c. More than 29%  


3. Which of the following statements are true? 


a. Low back pain (LBP) is defined as pain and/or discomfort below the costal margin and above the superior gluteal folds, with or without leg pain.  
b. Non-specific LBP is defined as tension, soreness and/or stiffness in the lower back that is not attributed to a known specific pathology 
c. In clinical practice, there are very sharp distinctions between acute, subacute and persistent LBP.  


4. Mrs Jones comes to see you with a six week history of back pain. She is fit and healthy and has no past medical history. Her pain is confined to the low back and with no radiation to either leg. What would you NOT do? 

a. Examine Mrs Jones  
b. Prescribe/advise a short course of simple analgesia  
c. Arrange for Mrs Jones to have x-ray or MRI  
d. Refer Mrs Jones for physiotherapy  
e. Reassure Mrs Jones and advise her to stay active   

5. Evidence based treatments for acute low back pain include: 
Choose at least one answer.  

a. NSAIDs  
b. Advice to stay active  
c. Alternating hot and cold pads  
d. Muscle relaxants  
e. Lumbar supports  


6. Mr Singh has been to see you on a number of occasions with low back pain over a period of a year. He has been managed according to the NICE guidelines having had group exercise and acupuncture and also was referred to the orthopaedic surgeons and had no identifiable lesion requiring surgery. He is keen to get back to running his business full time and asks what else is available. What would be the most appropriate treatment recommendation now? Choose at least one answer.  


a. Manual therapy
b. Referral to an outpatient physiotherapy clinic  
c. An intensive back pain treatment programme  
d. Surgical treatment  

7. What investigations would you consider for Miss Charles, a 30 year old female secretary  with simple mechanical low back pain of six week duration? 

a. An x-ray of the lumbar spine  
b. A full blood count  
c. MRI  
d. ESR or plasma viscosity  
e. You shouldn’t arrange any investigations  

8. Mrs Evans has a six week history of low back pain and you previously diagnosed simple mechanical back pain. He was referred to physiotherapy who sent him for an MRI scan which showed he had a bulging disc at L 4/5 level and he has returned requesting stronger analgesia. What proportion of people WITHOUT back pain have signs of bulging discs on MRI scans? 

a. less than 1% 
b. 1-5% 
c. 6-19% 
d. 20% or more  

9.  When should screening for biopsychosocial risks to recovery be undertaken?

 
a. At initial presentation  
b. two weeks following presentation 
c. following 3 visits to the GP 
d. At six months 

10. You see Mr Foster after a three week history of low back pain. He tells you he has been taking his wife’s painkillers which she uses for cramps she gets that accompany her periods. You dissuade Mr Foster from taking these, he has no history of serious illness and no allergies to medication. Which painkillers should you initially advise? 

a. A weak opioid  
b. A prescription only NSAID such as diclofenac or naproxen  
c. Paracetamol, as required  
d. Paracetamol, 2 tablets four times a day  


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