Welcome to this month’s What’s Your Diagnosis Challenge!
But before we begin, check to see if you got the previous case on Abdominal Pain: Update on Emergency Department Management of Appendicitis and Diverticulitis correct.
Case Presentation: Emergency Department Management of Patients With Low Back Pain: A Review of Current Evidence
A 57-year-old woman presents to the ED with back pain…
- She arrives clutching her back and limps to the gurney. She said she has had low back pain before, but it is more severe today.
- Her vital signs are: temperature, 36.7°C; heart rate, 95 beats/min; blood pressure, 161/95 mm Hg; respiratory rate, 22 breaths/min; and oxygen saturation, 98% on room air.
- On examination, you elicit pain, without radiation, with palpation of her right lower back and elevation of her leg. You wonder whether this presentation warrants imaging and how best to treat her pain…
Case Conclusion
You conducted a history and physical examination, and you screened her for red flags. Her vital signs were normal, and she did not have concerning factors that indicated infectious, neurologic, traumatic, or intra-abdominal emergencies. Since there was no trauma and no neurologic deficits, no imaging was obtained, and you diagnosed musculoskeletal LBP. You treated her symptoms with oral ibuprofen 400 mg, which improved her pain.
The patient was discharged with a referral to the back clinic and physical therapy, and a prescription for oral naproxen 500 mg twice a day, with food, for 1 week. She was also provided clear instructions on when she should return to the ED, guidance to avoid bed rest and heavy lifting, and a recommendation to resume daily activities as tolerated.
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Last Updated on January 6, 2025
