Tips for GPs
Exclude serious pathology - need for emergency admission/ urgent investigations - Reassure patients you have done this. See the red flags section.
- Give safe and adequate analgesia- be prepared to review this
- Give good information - see the information leaflets for LBP and Sciatica
- Screen for Yellow flags - fear of movement, catastrophising, emotional or work issues, STaRT back questionnaire good tool for this (link to yellow pages section)
What difference does it make if the patient has Sciatica?
The initial treatment is really the same as above. However patients should be warned to watch out for signs of cauda equina. It also helps to inform your advice, and may dictate how soon you review them/ refer them- It is likely they will suffer more pain and disability. You may consider earlier referral to the back pain specialist team.
How do I tell if leg pain is true sciatica?
- history - The Quality of the pain is crucial-Is it sharp electric/burning like pain?
- Pain distribution often follows sclerodermal patterns (L4 front of whole leg, L5- lateral aspect of whole leg, S1 back of whole leg)
- Usually leg pain is worse than the back pain
- Examination - Slump test, this is a great test because you can do it with patient sitting in their chair!
When do I need to examine patients?
As a general rule, it's a good idea to 'at least look at the back' and to get the patient to do some basic movements.
- It gives the patient confidence that you have looked at them properly (this adds weight to your advice- the key aspect)
- You avoid missing obvious deformities
- Helps give a feel for how fearful they are of moving
- If they have symptoms of sciatica you need to exclude signs of neurological compromise
- quick exam can be - get patient to squat down and stand up, and walk on heels/ and tip toes (if can do all myotomes intact), normal sensation to touch over medial and lateral thigh, calf and foot (covers all dermatomes L2-S1)
When should I be suspicious of inflammatory back pain?
Younger patients especially men, with pain that gets worse throughout the night, and stay stiff in the mornings. They often improve with exercise (link to inflammatory back pain)