Back Pain

Table of Contents

Aliases

None

Patient Care Goals

  1. Improve patient discomfort
  2. Identify life-threatening causes of back pain

Patient Presentation

Inclusion Criteria

Back pain or discomfort related to a non-traumatic cause or when pain was due to non-acute trauma (e.g. chronic pain conditions)

Exclusion Criteria

  1. Back pain from spinal trauma [see Trauma guidelines]
  2. Back pain due to sickle cell pain crisis [see Sickle Cell Pain Crisis guideline]
  3. Back pain from suspected labor [see OB/GYN guidelines]

Patient Management

Assessment

  1. Perform airway assessment and management, per the Airway Management guideline
  2. Obtain vital signs including pulse, respiratory rate, pulse oximetry, and blood pressure
  3. Provide evaluation and management of pain, per the Pain Management guideline
  4. Obtain vascular access as necessary to provide analgesia and/or fluid resuscitation
  5. Assess for life-threatening causes of back pain, which may include:
    1. Spinal cord compression (e.g. from spinal epidural abscess, malignancy, spinal epidural hematoma for patients on anticoagulants)
      1. Urinary and/or bowel incontinence
      2. Inability to walk due to weakness
      3. New neurologic deficits in extremities
      4. Loss of sensation in saddle distribution
    2. Aortic dissection or ruptured abdominal aortic aneurysm
      1. Unequal femoral or distal lower extremity pulses
      2. “Pulsatile” abdominal mass
      3. Associated abdominal pain and/or chest pain
      4. Known history of abdominal aortic aneurysm or dissection
    3.  Pyelonephritis
      1. Fever
      2. Nausea, vomiting
      3. Urinary frequency/urgency
      4. Dysuria
      5. Hematuria
      6. Abdominal pain
      7. Costovertebral angle tenderness to percussion
  6. Assess for signs of shock. If shock is present, provide treatment per appropriate Shock guideline
  7. Assess for other non-life threatening causes of abdominal pain
    1. Kidney stone
      1. Unilateral flank pain
      2. Nausea, vomiting
      3. Possible hematuria
      4. History of kidney stones

Treatment and Interventions

  1. Medication Administration
    1. Provide analgesia, per Pain Management guideline
    2. Administer antiemetics, per Nausea-Vomiting guideline
  2. Provide transport to an appropriate receiving facility – Consider specialty destination centers for conditions such as suspected aortic emergency or ruptured ectopic pregnancy
  3. Reassess vital signs and response to therapeutic interventions throughout transport

Notes – Back Pain