Low Back is one of the most common complaints that we see in the Emergency Department.Our first priority is to rule out those causes that can lead to paralysis or death (i.e.: epidural abscess, pathological fracture, cauda equina syndrome, etc…).However, most of the back pain that we will see is musculoskeletal in origin.
The American College of Physicians (ACP) and the American Pain Society (APS) recently released some joint recommendations on the evaluation of treatment of individuals with back pain.
In summary their key recommendations are:
Routine imaging is not required. However, diagnostic imagingand testing should be obtained for patients with low back pain when severe or progressiveneurologic deficits are present or when serious underlying conditionsare suspected.
For patients with low back pain, cliniciansshould consider the use of medications with proven benefitsin conjunction with back care information and self-care. For most patients, first-line medicationoptions are acetaminophen or nonsteroidal anti-inflammatorydrugs.
Medications that have good evidence of short-term effectiveness for low back pain are NSAIDs, acetaminophen, skeletal muscle relaxants (for acute low back pain), and tricyclic antidepressants (for chronic low back pain).
Links to the Clinical Guidelines are listed below:
