Acute Back Pain: Does My Patient Need a Study?
Low Back Pain. Those three words can make even the most seasoned clinician wince. Since L/S spinal pain is so common, no matter the specialty, all medical providers are likely to encounter patients with complaints of low back pain. The evaluation of low back pain in adults has several guidelines. Here we focus on the initial evaluation of acute low back pain.
Acute low back pain rarely needs imaging. The exception to this rule is significant trauma. In the absence of significant trauma, most patients with acute low back pain (a duration of less than four to six weeks) do not require immediate imaging. Here is a link for an algorithm to help identify the 5 percent of patients who present in the office setting and need immediate imaging.
As you will see, the exceptions include:
- Signs or symptoms of cauda equine
- Significant neurologic deficits
- Current or recent cancer history (except non-melanoma skin cancer)
- High risk for cancer
- Signs, symptoms or risk factors for spinal infection
- Risk for vertebral compression fracture
Approximately 95 percent of patients who present with acute low back pain can begin conservative therapy for four to six weeks without the need for imaging.
Patients may expect or request an imaging study to be ordered. This can be especially true at an initial visit for back pain. Taking a focused history to rule out the exceptions on the algorithm and performing a careful physical exam can often reassure the patient. As you may already know, incidental findings on imaging studies can lead to unnecessary work-up with additional testing, referrals and possibly even invasive interventions.
Patients with chronic back pain follow a different algorithm. A future edition of this e-newsletter will address the topic of chronic low back pain.
For your patients with acute low back pain, the majority will improve in less than seven weeks. Most patients will be pain-free again in as little as two to four weeks. Your guidance of their care is greatly appreciated. Amida Care supports the appropriate use of referrals and imaging studies for all of our members.
Thank you for your continued care of our members.