Lower back pain - Revision history

Danbot: Add to Category:Symptoms - common EM chief complaint

2026-03-22T09:41:37Z

Add to Category:Symptoms - common EM chief complaint

← Older revision		Revision as of 09:41, 22 March 2026
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	<references/>		<references/>

			[[Category:Symptoms]]
	[[Category:Orthopedics]]		[[Category:Orthopedics]]

Rossdonaldson1: /* Video */

2024-04-17T20:11:01Z

Video

← Older revision		Revision as of 20:11, 17 April 2024
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	==External Links==		==External Links==
	*[http://ddxof.com/back-pain/ DDxOf: Differential Diagnosis of Back Pain]		*[http://ddxof.com/back-pain/ DDxOf: Differential Diagnosis of Back Pain]

	~~==Video==~~

	~~{{#widget:YouTube\|id=vdrrzay7EOk}}~~

	==References==		==References==

Jrapa86: /* Imaging */

2023-03-30T09:28:27Z

Imaging

← Older revision		Revision as of 09:28, 30 March 2023
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	===Imaging===		===Imaging===
	*Multiple institutions advise '''against''' routine initial imaging of the lumbar spine in adults with acute non-traumatic low back pain, in the absence of severe progressive neurologic deficit, absence of red flags, and if <6 weeks in duration.<ref>ACEP - Lumbar spine imaging in the ED \| Choosing Wisely. October 27, 2014. Accessed March 30, 2023. https://www.choosingwisely.org/clinician-lists/acep-lumbar-spine-imaging-in-the-ed/</ref><ref>American College of Physicians. Five Things Physicians and Patients Should Question. Choosing Wisely Campaign. February 24, 2015. Accessed March 10, 2023. https://www.choosingwisely.org/societies/american-college-of-physicians/</ref><ref>American Academy of Family Physicians. Twenty Things Physicians and Patients Should Question. Choosing Wisely Campaign. 2021. Accessed March 10, 2023. https://www.choosingwisely.org/societies/american-academy-of-family-physicians/</ref><ref>American Society of Anesthesiologists. Five Things Physicians and Patients Should Question. Choosing Wisely Campaign. Published 2019. Accessed March 10, 2023. https://www.choosingwisely.org/societies/american-society-of-anesthesiologists-pain-medicine/</ref><ref>American College of Occupational and Environmental Medicine. Five Things Physicians and Patients Should Question. Choosing Wisely Campaign. Published 2022. Accessed March 10, 2023. https://www.choosingwisely.org/societies/american-college-of-occupational-and-environmental-medicine/</ref><ref>American Association of Neurological Surgeons and Congress of Neurological Surgeons. Five Things Physicians and Patients Should Question. Choosing Wisely Campaign. Published June 24, 2014. Accessed March 10, 2023. https://www.choosingwisely.org/societies/american-association-of-neurological-surgeons-and-congress-of-neurological-surgeons/</ref><ref>American Chiropractic Association. Five Things Physicians and Patients Should Question. Choosing Wisely Campaign. Published 2021. Accessed March 10, 2023. https://www.choosingwisely.org/societies/american-chiropractic-association/</ref><ref>Five Things Physicians and Patients Should Question. Choosing Wisely Campaign. Published 2022. Accessed March 10, 2023. https://www.choosingwisely.org/societies/north-american-spine-society/</ref>		*Multiple institutions advise '''against''' routine initial imaging of the lumbar spine in adults with acute non-traumatic low back pain, in the absence of severe progressive neurologic deficit, absence of red flags, and if <6 weeks in duration.<ref>ACEP - Lumbar spine imaging in the ED \| Choosing Wisely. October 27, 2014. Accessed March 30, 2023. https://www.choosingwisely.org/clinician-lists/acep-lumbar-spine-imaging-in-the-ed/</ref><ref>American College of Physicians. Five Things Physicians and Patients Should Question. Choosing Wisely Campaign. February 24, 2015. Accessed March 10, 2023. https://www.choosingwisely.org/societies/american-college-of-physicians/</ref><ref>American Academy of Family Physicians. Twenty Things Physicians and Patients Should Question. Choosing Wisely Campaign. 2021. Accessed March 10, 2023. https://www.choosingwisely.org/societies/american-academy-of-family-physicians/</ref><ref>American Society of Anesthesiologists. Five Things Physicians and Patients Should Question. Choosing Wisely Campaign. Published 2019. Accessed March 10, 2023. https://www.choosingwisely.org/societies/american-society-of-anesthesiologists-pain-medicine/</ref><ref>American College of Occupational and Environmental Medicine. Five Things Physicians and Patients Should Question. Choosing Wisely Campaign. Published 2022. Accessed March 10, 2023. https://www.choosingwisely.org/societies/american-college-of-occupational-and-environmental-medicine/</ref><ref>American Association of Neurological Surgeons and Congress of Neurological Surgeons. Five Things Physicians and Patients Should Question. Choosing Wisely Campaign. Published June 24, 2014. Accessed March 10, 2023. https://www.choosingwisely.org/societies/american-association-of-neurological-surgeons-and-congress-of-neurological-surgeons/</ref><ref>American Chiropractic Association. Five Things Physicians and Patients Should Question. Choosing Wisely Campaign. Published 2021. Accessed March 10, 2023. https://www.choosingwisely.org/societies/american-chiropractic-association/</ref><ref>Five Things Physicians and Patients Should Question. Choosing Wisely Campaign. Published 2022. Accessed March 10, 2023. https://www.choosingwisely.org/societies/north-american-spine-society/</ref>
			**Part of [[Choosing wisely ACEP\|ACEP Choosing wisely ]]

	*Plain films		*Plain films
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	*CT		*CT
	**Better for identification of fractures.		**Better for identification of fractures.
	**Part of [[Choosing wisely ACEP\|ACEP Choosing wisely ]]
	*MRI		*MRI
	**Only necessary if suspect infection, neoplasm, [[epidural compression syndromes]]		**Only necessary if suspect infection, neoplasm, [[epidural compression syndromes]]

Jrapa86: /* Imaging */

2023-03-30T04:57:46Z

Imaging

← Older revision		Revision as of 04:57, 30 March 2023
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	*Plain films		*Plain films
	**~~Only necessary~~ if suspect fracture, tumor, or infection		**May consider if suspect fracture, tumor, or infection, however, of low utility.
			*CT
			**Better for identification of fractures.
	**Part of [[Choosing wisely ACEP\|ACEP Choosing wisely ]]		**Part of [[Choosing wisely ACEP\|ACEP Choosing wisely ]]
	*MRI		*MRI

Jrapa86: /* Imaging */

2023-03-30T04:50:12Z

Imaging

← Older revision		Revision as of 04:50, 30 March 2023
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	===Imaging===		===Imaging===
	*Multiple institutions advise '''against''' routine initial imaging of the lumbar spine in adults with acute non-traumatic low back pain, in the absence of severe progressive neurologic deficit, red flags, and if <6 weeks in duration.<ref>ACEP - Lumbar spine imaging in the ED \| Choosing Wisely. October 27, 2014. Accessed March 30, 2023. https://www.choosingwisely.org/clinician-lists/acep-lumbar-spine-imaging-in-the-ed/</ref><ref>American College of Physicians. Five Things Physicians and Patients Should Question. Choosing Wisely Campaign. February 24, 2015. Accessed March 10, 2023. https://www.choosingwisely.org/societies/american-college-of-physicians/</ref><ref>American Academy of Family Physicians. Twenty Things Physicians and Patients Should Question. Choosing Wisely Campaign. 2021. Accessed March 10, 2023. https://www.choosingwisely.org/societies/american-academy-of-family-physicians/</ref><ref>American Society of Anesthesiologists. Five Things Physicians and Patients Should Question. Choosing Wisely Campaign. Published 2019. Accessed March 10, 2023. https://www.choosingwisely.org/societies/american-society-of-anesthesiologists-pain-medicine/</ref><ref>American College of Occupational and Environmental Medicine. Five Things Physicians and Patients Should Question. Choosing Wisely Campaign. Published 2022. Accessed March 10, 2023. https://www.choosingwisely.org/societies/american-college-of-occupational-and-environmental-medicine/</ref><ref>American Association of Neurological Surgeons and Congress of Neurological Surgeons. Five Things Physicians and Patients Should Question. Choosing Wisely Campaign. Published June 24, 2014. Accessed March 10, 2023. https://www.choosingwisely.org/societies/american-association-of-neurological-surgeons-and-congress-of-neurological-surgeons/</ref><ref>American Chiropractic Association. Five Things Physicians and Patients Should Question. Choosing Wisely Campaign. Published 2021. Accessed March 10, 2023. https://www.choosingwisely.org/societies/american-chiropractic-association/</ref><ref>Five Things Physicians and Patients Should Question. Choosing Wisely Campaign. Published 2022. Accessed March 10, 2023. https://www.choosingwisely.org/societies/north-american-spine-society/</ref>		*Multiple institutions advise '''against''' routine initial imaging of the lumbar spine in adults with acute non-traumatic low back pain, in the absence of severe progressive neurologic deficit, absence of red flags, and if <6 weeks in duration.<ref>ACEP - Lumbar spine imaging in the ED \| Choosing Wisely. October 27, 2014. Accessed March 30, 2023. https://www.choosingwisely.org/clinician-lists/acep-lumbar-spine-imaging-in-the-ed/</ref><ref>American College of Physicians. Five Things Physicians and Patients Should Question. Choosing Wisely Campaign. February 24, 2015. Accessed March 10, 2023. https://www.choosingwisely.org/societies/american-college-of-physicians/</ref><ref>American Academy of Family Physicians. Twenty Things Physicians and Patients Should Question. Choosing Wisely Campaign. 2021. Accessed March 10, 2023. https://www.choosingwisely.org/societies/american-academy-of-family-physicians/</ref><ref>American Society of Anesthesiologists. Five Things Physicians and Patients Should Question. Choosing Wisely Campaign. Published 2019. Accessed March 10, 2023. https://www.choosingwisely.org/societies/american-society-of-anesthesiologists-pain-medicine/</ref><ref>American College of Occupational and Environmental Medicine. Five Things Physicians and Patients Should Question. Choosing Wisely Campaign. Published 2022. Accessed March 10, 2023. https://www.choosingwisely.org/societies/american-college-of-occupational-and-environmental-medicine/</ref><ref>American Association of Neurological Surgeons and Congress of Neurological Surgeons. Five Things Physicians and Patients Should Question. Choosing Wisely Campaign. Published June 24, 2014. Accessed March 10, 2023. https://www.choosingwisely.org/societies/american-association-of-neurological-surgeons-and-congress-of-neurological-surgeons/</ref><ref>American Chiropractic Association. Five Things Physicians and Patients Should Question. Choosing Wisely Campaign. Published 2021. Accessed March 10, 2023. https://www.choosingwisely.org/societies/american-chiropractic-association/</ref><ref>Five Things Physicians and Patients Should Question. Choosing Wisely Campaign. Published 2022. Accessed March 10, 2023. https://www.choosingwisely.org/societies/north-american-spine-society/</ref>

	*Plain films		*Plain films

Jrapa86: /* Imaging */

2023-03-30T04:48:49Z

Imaging

← Older revision		Revision as of 04:48, 30 March 2023
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	===Imaging===		===Imaging===
			*Multiple institutions advise '''against''' routine initial imaging of the lumbar spine in adults with acute non-traumatic low back pain, in the absence of severe progressive neurologic deficit, red flags, and if <6 weeks in duration.<ref>ACEP - Lumbar spine imaging in the ED \| Choosing Wisely. October 27, 2014. Accessed March 30, 2023. https://www.choosingwisely.org/clinician-lists/acep-lumbar-spine-imaging-in-the-ed/</ref><ref>American College of Physicians. Five Things Physicians and Patients Should Question. Choosing Wisely Campaign. February 24, 2015. Accessed March 10, 2023. https://www.choosingwisely.org/societies/american-college-of-physicians/</ref><ref>American Academy of Family Physicians. Twenty Things Physicians and Patients Should Question. Choosing Wisely Campaign. 2021. Accessed March 10, 2023. https://www.choosingwisely.org/societies/american-academy-of-family-physicians/</ref><ref>American Society of Anesthesiologists. Five Things Physicians and Patients Should Question. Choosing Wisely Campaign. Published 2019. Accessed March 10, 2023. https://www.choosingwisely.org/societies/american-society-of-anesthesiologists-pain-medicine/</ref><ref>American College of Occupational and Environmental Medicine. Five Things Physicians and Patients Should Question. Choosing Wisely Campaign. Published 2022. Accessed March 10, 2023. https://www.choosingwisely.org/societies/american-college-of-occupational-and-environmental-medicine/</ref><ref>American Association of Neurological Surgeons and Congress of Neurological Surgeons. Five Things Physicians and Patients Should Question. Choosing Wisely Campaign. Published June 24, 2014. Accessed March 10, 2023. https://www.choosingwisely.org/societies/american-association-of-neurological-surgeons-and-congress-of-neurological-surgeons/</ref><ref>American Chiropractic Association. Five Things Physicians and Patients Should Question. Choosing Wisely Campaign. Published 2021. Accessed March 10, 2023. https://www.choosingwisely.org/societies/american-chiropractic-association/</ref><ref>Five Things Physicians and Patients Should Question. Choosing Wisely Campaign. Published 2022. Accessed March 10, 2023. https://www.choosingwisely.org/societies/north-american-spine-society/</ref>

	*Plain films		*Plain films
	**Only necessary if suspect fracture, tumor, or infection		**Only necessary if suspect fracture, tumor, or infection
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	*MRI		*MRI
	**Only necessary if suspect infection, neoplasm, [[epidural compression syndromes]]		**Only necessary if suspect infection, neoplasm, [[epidural compression syndromes]]
	**Consider for back pain >6-8wks		**Consider for back pain >6-8wks, progressive neurologic deficit, or presence of red flags
			**'''Gold Standard:''' if [[cauda equina syndrome]] is suspected
	*Ultrasound		*Ultrasound
	**Rule-out [[Aortic ultrasound\|AAA]]		**Rule-out [[Aortic ultrasound\|AAA]]

Jrapa86: /* Cauda equina syndrome */

2023-03-29T14:06:06Z

Cauda equina syndrome

← Older revision		Revision as of 14:06, 29 March 2023
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	===[[Cauda equina syndrome]]===		===[[Cauda equina syndrome]]===
	*Immediate spine surgery consultation for spinal decompression to avoid permanent bowel/bladder/neurologic injury		*Immediate spine surgery consultation for spinal decompression to avoid permanent bowel/bladder/neurologic injury
			*Most common in young men<ref>Rider LS, Marra EM. Cauda Equina And Conus Medullaris Syndromes. In: StatPearls. StatPearls Publishing; 2023. Accessed March 29, 2023. http://www.ncbi.nlm.nih.gov/books/NBK537200/</ref>
			*The onset of perineal anesthesia associated with bladder dysfunction is typical of the start of cauda equina syndrome and the time at which the clock starts on diagnosis and management.<ref>Quaile A. Cauda equina syndrome-the questions. Int Orthop. 2019;43(4):957-961. doi:10.1007/s00264-018-4208-0</ref>
			*Painless urinary retention often has the greatest predictive value as a stand-alone symptom, but it is unfortunately indicative of late, often irreversible cauda equina syndrome<ref>Todd NV. Guidelines for cauda equina syndrome. Red flags and white flags. Systematic review and implications for triage. Br J Neurosurg. 2017;31(3):336-339. doi:10.1080/02688697.2017.1297364</ref>

	==Disposition==		==Disposition==

Rossdonaldson1: /* Management */

2022-05-12T19:01:02Z

Management

← Older revision		Revision as of 19:01, 12 May 2022
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	***Can be considered for moderate-severe pain but only for limited duration (<1 week)		***Can be considered for moderate-severe pain but only for limited duration (<1 week)
	***Associated with higher return rates to ED within 30 days for same complaint when compared to other modalities		***Associated with higher return rates to ED within 30 days for same complaint when compared to other modalities
	**[[Benzodiazepines]]
	***May consider Valium 5 mg PO for back spasms
	***Some studies suggest benzodiazepines have no benefit over [[NSAIDs]] alone<ref>Friedman BW, et al. "Diazepam is no better than placebo when added to Naproxen for acute low back pain." Annals of EM. August 2017. 70(2):169-176</ref>

	====Not Indicated====		====Not Indicated====
	*[[Steroids]]		*[[Steroids]]
	**Of unlikely effectiveness<ref>Holve, RL, et al. Oral steroids in initial treatment of acute sciatica. J Am Board Fam Med. 2008; 21(5):469-474. </ref><ref>Goldberg H, et al. Oral steroids for acute radiculopathy due to a herniated lumbar disk: a randomized clinical trial. JAMA. 2015 May 19;313(19):1915-23. PMID 25988461.</ref>		**Of unlikely effectiveness<ref>Holve, RL, et al. Oral steroids in initial treatment of acute sciatica. J Am Board Fam Med. 2008; 21(5):469-474. </ref><ref>Goldberg H, et al. Oral steroids for acute radiculopathy due to a herniated lumbar disk: a randomized clinical trial. JAMA. 2015 May 19;313(19):1915-23. PMID 25988461.</ref>
			*[[Benzodiazepines]]
			**No benefit over [[NSAIDs]] alone<ref>Friedman BW, et al. "Diazepam is no better than placebo when added to Naproxen for acute low back pain." Annals of EM. August 2017. 70(2):169-176</ref>

	===Acute, Radicular Back Pain (Sciatica)===		===Acute, Radicular Back Pain (Sciatica)===

Masoodrm: /* Acute, Non-traumatic, Non-Radicular Back Pain */

2022-04-30T15:44:45Z

Acute, Non-traumatic, Non-Radicular Back Pain

← Older revision		Revision as of 15:44, 30 April 2022
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	***Can be considered for moderate-severe pain but only for limited duration (<1 week)		***Can be considered for moderate-severe pain but only for limited duration (<1 week)
	***Associated with higher return rates to ED within 30 days for same complaint when compared to other modalities		***Associated with higher return rates to ED within 30 days for same complaint when compared to other modalities
			**[[Benzodiazepines]]
			***May consider Valium 5 mg PO for back spasms
			***Some studies suggest benzodiazepines have no benefit over [[NSAIDs]] alone<ref>Friedman BW, et al. "Diazepam is no better than placebo when added to Naproxen for acute low back pain." Annals of EM. August 2017. 70(2):169-176</ref>

	====Not Indicated====		====Not Indicated====
	*[[Benzodiazepines]]
	**No benefit over [[NSAIDs]] alone<ref>Friedman BW, et al. "Diazepam is no better than placebo when added to Naproxen for acute low back pain." Annals of EM. August 2017. 70(2):169-176</ref>
	*[[Steroids]]		*[[Steroids]]
	**Of unlikely effectiveness<ref>Holve, RL, et al. Oral steroids in initial treatment of acute sciatica. J Am Board Fam Med. 2008; 21(5):469-474. </ref><ref>Goldberg H, et al. Oral steroids for acute radiculopathy due to a herniated lumbar disk: a randomized clinical trial. JAMA. 2015 May 19;313(19):1915-23. PMID 25988461.</ref>		**Of unlikely effectiveness<ref>Holve, RL, et al. Oral steroids in initial treatment of acute sciatica. J Am Board Fam Med. 2008; 21(5):469-474. </ref><ref>Goldberg H, et al. Oral steroids for acute radiculopathy due to a herniated lumbar disk: a randomized clinical trial. JAMA. 2015 May 19;313(19):1915-23. PMID 25988461.</ref>

Masoodrm: /* Background */

2021-04-15T15:12:51Z

Background

← Older revision		Revision as of 15:12, 15 April 2021
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	==Background==		==Background==
	*Pain lasting >~~6wks~~ is risk factor for more serious disease		*May also be called lumbago, referring to pain in the muscles and joints of the lower back
			*Pain lasting > 6 weeks is risk factor for more serious disease
	*Night pain and unrelenting pain are worrisome symptoms		*Night pain and unrelenting pain are worrisome symptoms
	*Back pain in IV drug user is spinal infection until proven otherwise		*Back pain in IV drug user is spinal infection until proven otherwise
	*95% of herniated discs occur at L4-L5 or L5-S1 (for both pain extends below the knee)		*95% of herniated discs occur at L4-L5 or L5-S1 (for both pain extends below the knee)
	*Lumbago: acute, nonspecific back pain

	{{Back pain red flags}}		{{Back pain red flags}}