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HWN Suggests

Low Back Pain Emergencies

Upwards of 90% of low back pain presentations in the ED are due to benign causes. However there are several important life/limb- threatening diagnoses we must consider in the low back pain patient, and most of these diagnoses are easy to miss...

The 5 emergent pathologies are:

• infection such as osteomyelitis, or spinal epidural abscess,
• fracture (trauma or pathologic),
• disk herniation & cord compression,
• cancer in spine causing cord compression,
• vascular – leaking/ruptured AAA, retroperitoneal bleed, and spinal epidural hematoma.

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Featured

 Low Back Pain – a management guide

The vast majority of physicians will already appreciate red flags and when to investigate patient’s further, so this article will only focus on mechanical low back pain.

 Treating Acute Low Back Pain – It's Tricky, Tricky, Tricky

There still appears to be no great treatment options for patients presenting with acute low back pain. Evidence for individual pharmaceutical therapies are limited and this trial provides evidence that a combination therapy of acetaminophen and ibuprofen is not better than ibuprofen alone. This agrees with the previous SGEM episode looking at a combination of diazepam and naproxen. We also don’t have high-quality evidence that non-pharmacological treatments work well.

Articles of Interest

Atraumatic Low Back Pain: ACEP E-QUAL Network Podcast

ALiEM has partnered with the ACEP E-QUAL Network to promote clinical practice improvements through a series of podcasts. In our first installment, we focus on this common presentation.

Back to Basics: Treatment of Acute Low Back Pain in the ED

This review focuses on emergency department-relevant treatment of this subtype of acute back pain rather than the treatment of specific etiologies of back pain.

EM@3AM: Back Pain

Low back pain is among the most common presenting complaints in the ED, and while most of the patients end up having acute non-specific back pain, there are several very serious causes of low back pain that can have devastating consequences if not detected and treated promptly.

Erector spinae plane block: a new option for managing acute axial low back pain in the emergency department

The erector spinae plane block (ESPB) is a nerve block used to treat thoracic, rib, spine and abdominal wall pain. There is currently limited evidence to support its use in treating low back pain in the ED.

Is there a role for a single intravenous bolus dose of corticosteroid in reducing pain in Emergency Department patients with radicular back pain?

The current data does not provide definitive support for the use of a single bolus dose of IV corticosteroid for acute radicular LBP in the ED. Although a small benefit of this treatment was seen in two RCTs, there are concerns regarding the validity of these trials. Additionally the sample sizes of these trials may be too small to detect rare and dangerous adverse effects. Therefore, further studies are needed to establish the efficacy and safety of single-dose IV bolus of corticosteroids for radicular LBP.

Low Back Pain Emergencies Could Signal Neurological Injuries

For whatever reason, there’s a tendency to be nonchalant and complacent about low back pain. That is odd because if you compare the 90 percent of low back pain comprising benign causes to chest pain, it’s not very different. Only about 10 percent to 15 percent of chest pain presentations to the emergency department turn out to be serious. Yet when it comes to patients presenting to the emergency department with chest pain, we’re keenly alert about ruling out myocardial infarction, pulmonary embolism, aortic dissection, etc.

Non-Traumatic Low Back Pain

Patients with red flags along with their back pain should be considered for imaging (MRI) in the ED.