Low back pain is a common presentation in the emergency department, and determining whether the cause is benign or life-threatening can be challenging. A systematic strategy for the history and physical examination can help reduce unecessary imaging, and an evidence-based approach will inform safe and effective pain management recommendations.
Our recent issue Emergency Department Management of Patients With Low Back Pain: A Review of Current Evidence reviews the evidence on red flag signs and symptoms for low back pain, current diagnostic studies recommendations, and best-practice treatment and disposition strategies.
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Here are a few key points:
- Although most low back pain (LBP) seen in the ED is from benign causes, given the high risk for patient disability and death associated with dangerous etiologies, emergency clinicians must use a systematic approach to manage these patients in order to avoid anchoring bias.
- LBP causes can be grouped into 4 general categories: mechanical, infectious, inflammatory, and referred pain. (See Table 2 in the issue.)
- Many ”red flag“ features have been noted (see Table 3 in the issue), but few have data supporting them; those that do are noted in Table 4 in the issue.
- The presence of more than 1 red-flag feature should raise clinical suspicion for a serious spinal pathology.
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