Episode 206: Acute Back Pain

We discuss the evaluation of and treatment options for acute back pain.

Hosts:
Benjamin Friedman, MD
Brian Gilberti, MD

Download Leave a Comment Tags: Musculoskeletal, Orthopaedics

Show Notes

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Clinical Evaluation:

• Primary Goal: Distinguish benign musculoskeletal pain from serious pathology.
• Red Flags: Look for indicators of spinal infection, spinal bleed, or space-occupying lesions (e.g., tumors, large herniated discs).
• Assessment: A thorough history and neurological exam (strength testing, gait) is essential.
• Additional Tools: Use bedside ultrasound for post-void residual assessment in suspected cauda equina syndrome

Imaging Guidelines:

• Routine Imaging: Generally not indicated for young, healthy patients without red flags.
• ACEP Recommendations: Avoid lumbar X-rays in patients under 50 without risk factors, as they do not change management and may increase costs and ED time.
• Advanced Imaging: Reserve MRI for patients with red flags, neurological deficits, or suspected cauda equina syndrome; CRP may be a part of your calculus when evaluating for infectious causes of back pain

Treatment Options:

• Evidence-Based First-Line:
  • NSAIDs offer modest benefit.