Acute Lower Back Pain

Authors: Frank Edenborough, Shammi L Ramlakhan / Editor: Jason M Kendall / Reviewer: Stewart McMorran, Grace McKay / Codes: / Published: 25/03/2021

Lower back pain is a very common problem and it is estimated that 80% of the population suffer from it at some stage of their life. It is also a common presentation to emergency departments.

Emergency physicians must be able to differentiate serious from less serious causes of lower back pain and be able to recognise cauda equina compression syndrome

After completing this session you will be able to:

  • Describe the major causes of lower back pain
  • Identify the “red flags” for lower back pain
  • Describe the investigation of lower back pain
  • Plan the emergency department management of the common causes of lower back pain

References:

  1. Clinical Standards Advisory Group Committee on Back Pain (Chair Rosen M). (1994) Back pain. HMSO London.
  2. The Epidemiology and Cost of Back Pain. (1994) Annex to the Clinical Standards Advisory Groups Report on Back Pain (Chair Rosen M). Back pain. HMSO London.
  3. Speed C. ABC of rheumatology: low back pain. BMJ 2004;328:1119-1121.
  4. Koes BW, van Tulder MW, Thomas S. Diagnosis and treatment of low back pain. BMJ,2006;332:1430-1434.
  5. Kendrick D, Fielding K, Bentley E, Krslake R, Miller P, Pringle M.Radiography of the lumbar spine in primary care patients with low back pain; randomised controlled trial. BMJ 2001:322:400-405.
  6. Carley S. Early radiography in acute lower back pain
  7. Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews, 2007. Issue 4. Art. No.: CD000396. DOI: 10.1002/14651858.CD000396.pub3.
  8. Carley S. NSAIDS in acute low back pain.
  9. Van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low back pain. Cochrane Database of Systematic Reviews, 2003, Issue 3. Art. No.: CD004252. DOI: 10.1002/14651858.CD004252.
  10. Carley S. Muscle relaxants for acute low back pain.
  11.  Hagen KB, Hilde G, Jamtvedt G, Winnem M. Bed rest for acute low back pain and sciatica. Cochrane Database of Systematic Reviews, 2004 Issue 3. Art. No.: CD001254. DOI: 10.1002/14651858.CD001254.pub2.
  12. Carley, S. Bed rest for acute simple lower back pain.
  13. MacAuley D. Back pain and physiotherapy. BMJ 2004, 329, pp. 694-695.
  14. Frost H., Lamb SE, Doll HA, Carver PT, Stewart-Brown S. Randomised controlled trial of physiotherapy compared with advice for low back pain. BMJ 2004, 329, 708-711.
  15. UK BEAM Trial Team. United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ 2004;329:1377-1381.
  16. Clarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJMG, Bronfort G, Bouter LM. Traction for low back pain with or without sciatica. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD003010.DOI:10.1002/14651858.CD003010.pub4.
  17. Furlan AD, Brosseau L, Imamura M, Irvin E. Massage for low back pain. Cochrane Database of Systematic Reviews, 2002 Issue 1. Art. No.: CD001929. DOI: 10.1002/14651858.CD001929.
  18. Carley S. Massage therapy for acute low back pain.
  19.  Urquhart DM, Hoving JL, Assendelft WWJJ, Roland M, van Tulder MW. Antidepressants for non-specific low back pain. Cochrane Database of Systematic Reviews, 2008, Issue 1. Art. No.: CD001703. DOI: 10.1002/14651858.CD001703.pub3.
  20. French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ.  Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews, 2006, Issue 1. Art. No.: CD004750. DOI: 10.1002/14651858.CD004750.pub2.
  21. French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews, 2006, Issue 1. Art. No.: CD004750. DOI: 10.1002/14651858.CD004750.pub2.
  22. Engers A, Jellema P, Wensing M, van der Windt DAWM, Grol R, van Tulder MW. Individual patient education for low back pain. Cochrane Database of Systematic Reviews, 2008, Issue 1. Art. No.: CD004057. DOI: 10.1002/14651858.CD004057.pub3.
  23. Assendelft WJJ, Morton SC, Yu Emily I, Suttorp MJ, Shekelle PG. Spinal manipulative therapy for low back pain. Cochrane Database of Systematic Reviews, 2004, Issue 1. Art. No.: CD000447. DOI: 10.1002/14651858.CD000447.pub2.
  24. Hayden JA, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews, 2005, Issue 2. Art. No.: CD000335. DOI: 10.1002/14651858.CD000335.pub2.
  25. Carley S. Exercise for acute back pain.
  26. van Duijvenbode ICD, Jellema P, van Poppel MNM, van Tulder MW. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews, 2008, Issue 1. Art. No.: CD001823. DOI: 10.1002/14651858.CD001823.pub3.
  27. Carley S. Acupuncture in acute back pain.
  28. Carley S. Strong opiates in the treatment of acute low back pain.
  29. Pengel LHM, Herbert RD, Maher CG, Refshauge KM. Acute low back pain; systematic review of its prognosis. BMJ 2003;327:323-325.
  30. Thomas E, Silman AJ, Papageorgiou AC, Jayson MIV, MacFarlane GJ. Predicting who develops chronic low back pain in primary care: a prospective study. BMJ 1999;318:1662-1667.
  31. Staal JB, de Bie R, de Vet HCW, Hildebrandt J, Nelemans P. Injection therapy for subacute and chronic low back pain. Cochrane Database of Systematic Reviews, 2008, Issue 3. Art. No.: CD001824. DOI: 10.1002/14651858.CD001824.pub3.
  32. Gibson JNA, Waddell G. Surgical interventions for lumbar disc prolapse. Cochrane Database of Systematic Reviews, 2007, Issue 1. Art. No.: CD001350. DOI: 10.1002/14651858.CD001350.pub4.
  33. Peul WC, van den Hout WB, Brand R, Thomeer RTWM, Koes BW. Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial. BMJ 2007;336:1355-1358.
  34. Jalloh I, Minhas P. Delays in the treatment of cauda equina syndrome due to its variable clinical features in patients presenting to the emergency department. Emergency Medicine Journal 2007;24:33-34.
  35. NICE. Bisphosphonates (alendronate, etidronate, risedronate), selective oestrogen receptor modulators (raloxifene) and parathyroid hormone (teriparatide) for the secondary prevention of osteoporotic fragility fractures in postmenopausal women. National Institute for Clinical Excellence, 2005.
  36. NICE. Balloon vertebroplasy for vertebral compression fracture. National Institute for clinical Excellence, 2006.
  37. NICE. Percutaneous vertebroplasty. National Institute for clinical Excellence, 2003.
  38. NICE.Metastatic spinal cord compression. Diagnosis and management of adults and risk of and with metastatic spinal cord compression. National Institute for Clinical Excellence, 2007.
  39. Royal College of Physicians of London. Tuberculosis: Clinical diagnosis and management of tuberculosis, and measures for its prevention and control, 2006.
  40. Fairbank J. Prolapsed intervertebral disc. BMJ 2008;336:1317-1318.

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