Back Pain
Summary: <br> Step 1: Identify Classic Red Flags for Can’t Miss Diagnoses<br> <br> <br> <br> * 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<br> <br> <br> <br> Step 2: Testing Plan (If Patient Has Red Flags)<br> <br> <br> <br> * X-ray or CT scan if concerned for fracture* MRI if concerned for infection, cord compression, or cancer<br> <br> <br> <br> Step 3: Symptom Management<br> <br> <br> <br> * NSAIDS* Naproxen* Ibuprofen* “Muscle relaxants” * Cyclobenzaprine* Other agents* Opiates* Topical therapy* Lidocaine patches<br> <br> <br> <br> Step 4: Counseling<br> <br> <br> <br> * Remain active* Avoid heavy lifting* Red flags = immediate return to ED<br> <br> <br> <br> Additional Reading<br> <br> <br> <br> * Round 6 – Back Pain <a href="http://www.emclerkship.com/round-6-back-pain/">(EM Clerkship)</a>* Back Pain Red Flags <a href="https://www.wikem.org/wiki/Back_pain_(red_flags)">(WikEM)</a><br>
