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backpain_adult [2021/09/30 06:19] – [essentials of ED Mx:] gary1backpain_adult [2022/09/30 01:26] (current) wh
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 =====essentials of ED Mx:===== =====essentials of ED Mx:=====
-  ***if [[IVDU|IVDU]]** exclude sepsis - do a FBE and CRP, and if raised consider emergent MRI+  ***if [[IVDU|IVDU]], diabetic, immunocompromised or history of fever**exclude sepsis - do a FBE and CRP, and if raised consider emergent MRI
   ***avoid spine Xrays unless absolutely necessary** as high radiation dose to gonads, and ensure not pregnant, and yield is not high unless either:   ***avoid spine Xrays unless absolutely necessary** as high radiation dose to gonads, and ensure not pregnant, and yield is not high unless either:
     * significant trauma     * significant trauma
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     * unexplained raised CRP esp. if IVDU with back pain     * unexplained raised CRP esp. if IVDU with back pain
   ***if sciatica, assess as per approach to [[sciatica]]**   ***if sciatica, assess as per approach to [[sciatica]]**
-    *consider combinational Rx early - [[NSAIDs]],  paracetamol +/- [[oxycodone]] if very severe and unlikely to go home+    *consider combinational Rx early - [[NSAIDs]],  paracetamol (+/- [[oxycodone]] if very severe and unlikely to go home although opiates should be avoided where possible in most patients with back pain)
     *document SLR, neurology such as reflexes, lower limb neurology, bladder/bowel function     *document SLR, neurology such as reflexes, lower limb neurology, bladder/bowel function
     *care coordinator to assess mobility, etc     *care coordinator to assess mobility, etc
     *if unlikely to be able to mobilise sufficiently to go home, then discuss with ED senior for possible admission under general medicine or into EOU if likely to be able to go home next day     *if unlikely to be able to mobilise sufficiently to go home, then discuss with ED senior for possible admission under general medicine or into EOU if likely to be able to go home next day
-    *CT scan or MRI scan for low back pain is very unlikely to be helpful IF there are no red flags such as possible cauda equina syndrome, tumour, fracture or possible spinal abscess/discitis/haematoma+    *CT scan or MRI scan for low back pain is very unlikely to be helpful IF there are no **red flags** such as possible cauda equina syndrome, tumour, fracture or possible spinal abscess/discitis/haematoma
       *MRI scan in the absence of red flags, whilst giving information regarding the status of discs, does not improve the back pain but does increase the risk of neurosurgical referral, and potential neurosurgery procedure despite the fact that long term outcomes of these procedures are similar to patients not having these procedures(([[http://www.thennt.com/nnt/mri-vs-x-ray-for-lower-back-pain/|NNT.com]]))       *MRI scan in the absence of red flags, whilst giving information regarding the status of discs, does not improve the back pain but does increase the risk of neurosurgical referral, and potential neurosurgery procedure despite the fact that long term outcomes of these procedures are similar to patients not having these procedures(([[http://www.thennt.com/nnt/mri-vs-x-ray-for-lower-back-pain/|NNT.com]]))
 +    *finally, consider assessing **yellow flags for identifying psychosocial barriers to recovery:**
 +      * ascertain the following potential barriers:
 +        * presence of beliefs that back pain is harmful or potentially severely disabling
 +        * fear-avoidance behaviour (avoiding a movement or activity due to misplaced anticipation of pain) and reduced activity levels
 +        * tendency to low mood and withdrawal from social interaction
 +        * an expectation that passive treatments rather than active participation will help.
 +      * ask about:
 +        * Have you had time off work in the past with back pain?
 +        * What do you understand is the cause of your back pain?
 +        * What are you expecting will help you?
 +        * How is your employer responding to your back pain? Your co-workers? Your family?
 +        * What are you doing to cope with back pain?
 +        * Do you think that you will return to work? When?
   *if sacro-iliitis, check skin, nails for psoriasis, consider Xray for ankylosing spondylitis features, if male, ask about features of Reiter's   *if sacro-iliitis, check skin, nails for psoriasis, consider Xray for ankylosing spondylitis features, if male, ask about features of Reiter's
   *if chest pain radiating to back - exclude dissection, PE, pneumothorax, etc.   *if chest pain radiating to back - exclude dissection, PE, pneumothorax, etc.
  
backpain_adult.txt · Last modified: 2022/09/30 01:26 by wh

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