Acute non-specific back pain management in the emergency setting: A review of the literature

SummaryBack pain affects a large number of Australians each year. Patients frequently attend emergency departments with acute episodes of back pain. There is a growing body of evidence regarding management of non-specific back pain. A comprehensive review of the literature was undertaken to identify the current evidence base for management of non specific lower back pain. Clinicians managing patients presenting with lower back pain should exclude high risk illnesses with a diagnostic triage including a thorough history and physical examination. If signs and symptoms of serious pathology are excluded imaging and pathology tests are unwarranted. The literature suggests conservative management with simple analgesia and advice to maintain activity and avoid bed rest results in improved outcomes although a proportion of patients will progress to chronic back pain. Psychosocial and work factors are important in the progression to chronicity and clinicians should be aware of these risk factors. Further research is required to determine the clinical relevance of many aspects of the current management of lower back pain. This review provides an update for clinicians and suggests a conservative approach is appropriate in the management of most acute episodes of back pain presenting to the emergency department.