Back Pain

Step 1: Identify Classic Red Flags for Can’t Miss Diagnoses



* Aortic Dissection and Abdominal Aortic Aneurysm (AAA)* Age >50* Hypertension* “Ripping” or “Tearing” pain* Absent pulses in lower extremities* Spinal Infections* Fever* Immunocompromized* HIV* Diabetes mellitus* Transplant patients* Spinal cord compression (especially cauda equina)* Urinary retention* Consider obtaining post-void residual* Saddle anesthesia* Fecal incontinence/decreased rectal tone* Fracture* Recent trauma* Advanced age* Cancer* History of cancer* Night sweats* Weight loss



Step 2: Testing Plan (If Patient Has Red Flags)



* X-ray or CT scan if concerned for fracture* MRI if concerned for infection, cord compression, or cancer



Step 3: Symptom Management



* NSAIDS* Naproxen* Ibuprofen* “Muscle relaxants” * Cyclobenzaprine* Other agents* Opiates* Topical therapy* Lidocaine patches



Step 4: Counseling



* Remain active* Avoid heavy lifting* Red flags = immediate return to ED



Additional Reading



* Round 6 – Back Pain (EM Clerkship)* Back Pain Red Flags (WikEM)