Acute Lower Back Pain – RCEMLearning India

Authors: Henry Guly / Editor: John Sloan / Reviewer: Stewart McMorran, Grace McKay, Raghaventhar Manikandan / Codes: / Published: 25/03/2021 / Reviewed: 17/01/2025

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 the Emergency Department (ED).

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

START MODULE

References

Clinical Standards Advisory Group (CSAG) Back Pain Report of a CSAG Committee on Back Pain, Chaired by Professor Michael Rosen, London TSO, May 1994; ISBN 0 11 321887 7.
Speed C. Low back pain. BMJ 2004; 328 :1119.
Kendrick D, Fielding K, et al. Radiography of the lumbar spine in primary care patients with low back pain: randomised controlled trial. BMJ. 2001 Feb 17;322(7283):400-5.
Carley S. Early radiography in acute lower back pain. BestBETs, 2005.
Roelofs PD, Deyo RA, Koes BW, Scholten RJ, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database Syst Rev. 2008 Jan 23;2008(1):CD000396. doi: 10.1002/14651858.CD000396.pub3.
Carley S. NSAIDS in acute low back pain. BestBETs, 2005.
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.
Carley S. Muscle relaxants for acute low back pain. BestBETs, 2005.
Carley, S. Bed rest for acute simple lower back pain. BestBETs, 2005.
MacAuley D. Back pain and physiotherapy. BMJ 2004, 329, pp. 694-695.
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 Sep 25;329(7468):708.
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.
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.
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.
Carley S. Massage therapy for acute low back pain. BestBETs, 2005.
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.
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.
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.
Rubinstein SM, Terwee CB, Assendelft WJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database Syst Rev. 2012 Sep 12;2012(9):CD008880.
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.
Carley S. Exercise for acute back pain. BestBETs, 2005.
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.
Carley S. Acupuncture in acute back pain. BestBETs, 2005.
Carley S. Strong opiates in the treatment of acute low back pain. BestBETs, 2005.
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.
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.
Crandall CJ, Larson JC, LaCroix AZ, et al. Risk of Subsequent Fractures in Postmenopausal Women After Nontraumatic vs Traumatic Fractures. JAMA Intern Med. 2021 Aug 1;181(8):1055-1063.
National institute for Health and Care Excellence (NICE). Spinal metastases and metastatic spinal cord compression. NICE guideline [NG234], 2023.
National Institute for Health and Care Excellence (NICE). Low back pain and sciatica in over 16s: assessment and management. NICE guideline [NG59], 2016. Last updated: 11 December 2020
Pengel LHM, Herbert RD, Maher CG, Refshauge KM. Acute low back pain; systematic review of its prognosis. BMJ 2003;327:323-325.
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.
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. Emerg Med J. 2007 Jan;24(1):33-4.
Fairbank J. Prolapsed intervertebral disc. BMJ. 2008 Jun 14;336(7657):1317-8.