Notes – Back Pain

Back Pain

Patient Safety Considerations

No recommendations

Notes/Educational Pearls

Key Considerations

  1. Assess for life-threatening causes of back pain
  2. Provide appropriate treatment for pain, vomiting, and shock
  3. Consider transport to appropriate specialty center if aortic emergency suspected
  4. Back and abdominal pain can often coexist with similar disease processes
  5. Identify patients on anticoagulants since they are higher risk for spinal epidural hematoma or retroperitoneal hemorrhage which can present as back pain
  6. Identify patients with IVDA history and/or impaired immune system since they are higher risk for spinal epidural abscess
  7. Identify patients with a history of cancer or with one suspicious for cancer – spinal metastases can cause spinal cord compression

Pertinent Assessment Findings

  1. Midline back tenderness
  2. Back erythema or swelling
  3. Motor and/or sensory loss in arms or legs
  4. Loss of perianal sensation
  5. Absence of or significant inequality of femoral or distal arterial pulses in lower extremities
  6. Hyper or hypothermia
  7. Rectal bleeding or hematemesis

Quality Improvement

Associated NEMSIS Protocol(s) (eProtocol.01)

  • 9914051 – General-Back Pain

Key Documentation Elements

  • Assessment of back and abdomen to include findings on palpation/percussion including presence or absence of masses and presence and nature of tenderness/pain
  • Assesses initial and changes in neurologic status
  • Assesses initial and changes in perfusion/pulses

Performance Measures

  • Assessment for life-threatening etiology
  • Mitigation of pain, per the Pain Management guideline

References

None recommended