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Acute Low Back Pain
Book chapter

Acute Low Back Pain

Jesse M. Pines and Ali S. Raja
Evidence-based emergency care, pp 621-630
2023
DOI: https://doi.org/10.1002/9781119616870.ch55

Abstract

Diagnosis Diagnostic Techniques and Procedures Diseases Emergency medicine -- Decision making Emergency medicine -- Diagnosis Evidence-Based Emergency Medicine Evidence-Based Emergency Medicine -- methods Evidence-based medicine MEDICAL methods
The lifetime incidence of back pain is 90%, and low back pain accounted for 1.5 million emergency department visits in 2017. Low backpain may originate from the lumbar spine, vertebral ligaments, annulus fibrosus, vertebral periosteum, facet joints, paravertebral musculature, blood vessels, or spinal nerve roots. The duration of back pain should also be included when deciding whether and when to image patients. Steroid use increases the risk of compression fractures, but similar to cancer, the absence of these risk factors does not significantly reduce the posttest probability. The presence of sciatica significantly increases the risk of a disc herniation and the absence reduces the risk significantly. Guideline-derived algorithms have been shown to increase the efficiency of back pain test ordering in primary care and emergency settings, and currently represent the best approach to reduce variability without compromising patient care.

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