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Back Pain, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Low back pain (LBP):

    • Refers to pain in the area between the lower rib cage and the gluteal folds, often with radiation into the thighs

  • Sciatica:

    • Pain in the distribution of the lower lu...

Diagnosis

Signs and Symptoms

  • Musculoligamentous:

    • Poorly localized and dull back/gluteal pain without radiation past the knee.

    • Usually no objective neurologic signs.

    • Back spasm is a variable and poorly rep...

Treatment

Pre-Hospital

  • Immobilization is not generally recommended for nontraumatic pain.

  • Rapid transport for vascular concerns

Ed Treatment/Procedures

  • NSAIDs:

    • Musculoligamentous pain

    • Renal colic

    • Similar ben...

Follow-Up

Disposition

Admission Criteria

  • Severe pain with inability to ambulate

  • Pain unresponsive to ED management

  • Progressive neurologic deficits

  • Signs of cauda equina syndrome

  • Infectious, vascular, or neo...

Pearls and Pitfalls

  • Consider MRI for history of IVDA to rule out epidural abscess or if concerns of nonbony spinal metastases.

  • Elderly with minimal trauma may sustain fractures.

  • Consider vascular etiolo...

Additional Reading

  • Cantrill  SV, Brown  MD, Carlisle  RJ, et al. American College of Emergency Physicians Opioid Guideline Writing Panel. Clinical policy: Critical issues in the prescribing of opioids...

Codes

ICD9

  • 724.2 Lumbago

  • 724.3 Sciatica

  • 724.5 Backache, unspecified

ICD10

  • M54.5 Low back pain

  • M54.9 Dorsalgia, unspecified

  • M54.30 Sciatica, unspecified side

  • M54.40 Lumbago with sciatica, unspecified side

  • M54.3...

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