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April 15, 2025
Ula Hwang and Brian Gilberti discuss optimizing geriatric emergency care and identifying high-risk patients in emergency departments.
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<br /> <br /> <a href="https://coreem.net/podcast/episode-206-acute-back-pain/" title="Episode 206: Acute Back Pain" rel="bookmark"><br /> </a><br /> <br /> <br /> <br /> We discuss the evaluation of and treatment options for acute back pain.<br /> Hosts:<br /> Benjamin Friedman, MD<br /> Brian Gilberti, MD<br /> <br /> <br /> <br /> <a href="https://media.blubrry.com/coreem/content.blubrry.com/coreem/Acute_Back_Pain.mp3">https://media.blubrry.com/coreem/content.blubrry.com/coreem/Acute_Back_Pain.mp3</a> <br /> <br /> <br /> <br /> <a class="download" href="https://media.blubrry.com/coreem/content.blubrry.com/coreem/Acute_Back_Pain.mp3" title="Download" download>Download</a><br /> <br /> <br /> <a href="https://coreem.net/podcast/episode-206-acute-back-pain/#comments">Leave a Comment</a><br /> <br /> <br /> <br /> <br /> <br /> Tags: <a href="https://coreem.net/tag/musculoskeletal/" rel="tag">Musculoskeletal</a>, <a href="https://coreem.net/tag/orthopaedics/" rel="tag">Orthopaedics</a> <br /> <br /> <br /> <br /> <br /> <br /> Show Notes<br /> **Please fill out this quick survey to help us develop additional resources for our listeners: <a href="https://docs.google.com/forms/d/e/1FAIpQLSfoZwHn4xAZish_ldczUbtNRkUbAUzD9_1YuzBwGL7SPE0ymA/viewform?usp=header">Core EM Survey</a>**<br /> <br /> Clinical Evaluation:<br /> <br /> * Primary Goal: Distinguish benign musculoskeletal pain from serious pathology.<br /> * Red Flags: Look for indicators of spinal infection, spinal bleed, or space-occupying lesions (e.g., tumors, large herniated discs).<br /> * Assessment: A thorough history and neurological exam (strength testing, gait) is essential.<br /> * Additional Tools: Use bedside ultrasound for post-void residual assessment in suspected cauda equina syndrome<br /> <br /> Imaging Guidelines:<br /> <br /> * Routine Imaging: Generally not indicated for young, healthy patients without red flags.<br /> * ACEP Recommendations: Avoid lumbar X-rays in patients under 50 without risk factors, as they do not change management and may increase costs and ED time.<br /> * Advanced Imaging: Reserve MRI for patients with red flags, neurological deficits, or suspected cauda equina syndrome; CRP may be a part of your calculus when evaluating for infectious causes of back pain<br /> <br /> Treatment Options:<br /> <br /> * Evidence-Based First-Line:<br /> <br /> * NSAIDs offer modest benefit.<br /> * Skeletal muscle relaxants can be used but require caution due to side effects.<br /> <br /> <br /> * Ineffective Therapies:<br /> <br /> * Acetaminophen shows no benefit for back pain.<br /> * Steroids are not recommended for non-radicular pain, with only limited benefit in sciatica.<br /> * Topical treatments, lidocaine patches, and opioids are not supported by evidence and may pose additional risks.<br /> <br /> <br /> <br /> Alternative and Experimental Interventions:<br /> <br /> * Nerve Blocks: Current evidence is limited; more research is needed on trigger point injections and erector spinae plane blocks.<br /> * Severe Pain Management:<br /> <br /> * A single opioid dose (preferably codeine or oral morphine) may be considered to facilitate discharge when necessary.<br /> * Use diazepam sparingly for immediate mobilization.<br /> * Onsite physical therapy in the ED can be beneficial when available.<br /> <br /> <br /> * Preventing Chronic Pain:<br /> <br /> * Research Focus: Ongoing studies are evaluating whether duloxetine (Cymbalta) can prevent the transition from acute to chronic back pain.<br /> * Non-Pharmacologic Measures: Consider spinal mobilization, physical therapy, acupuncture, and cognitive behavioral therapy (CBT) as adjuncts in management.<br /> <br /> <br /> <br /> Take-Home Points:<br /> <br />
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