Skip to main content

Advertisement

SpringerLink
Log in

Spine Pain Management

  • Pain Management (S Mace, Section Editor)
  • Published:
Current Emergency and Hospital Medicine Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Spine pain is one of the most common complaints presenting to the emergency department and represents significant healthcare cost. Evaluation and workup of these patients can be difficult, and a proper history and physical exam will minimize unnecessary tests.

Recent Findings

Nontraumatic spine pain is most often idiopathic or related to muscle or ligamentous strain. Although musculoskeletal mechanisms are most commonly responsible, there are very rarely, but importantly, life-threatening conditions which present as spine pain, and these must be ruled out. The presence of neurologic deficit renders advanced imaging and neurosurgical consultation necessary. A subset of spine pain seen in the emergency department is chronic pain, and these cases require the full spectrum of pain management in order to address the associated symptoms which contribute to pain, and this can often be done in the outpatient setting. There is a positive correlation between psychological distress, insomnia, and depression with chronic pain. Efficiency is paramount in the emergency department, and simple screening tools such as the STarT Back Screening tool can be used to estimate prognosis in spine pain. Once a diagnosis is made, one can determine which pharmacologic treatment, if any, is necessary. Nonopioid, anti-inflammatory pain medications are most appropriate to treat acute inflammatory pain. Alternatively, cancer spine pain may require very high-dose opioids to adequately address pain crises, and chronic pain may require medications such as anti-convulsants, anti-depressants, or even atypical anti-psychotics.

Summary

There is no perfect method for evaluating and diagnosing spine pain, however utilizing the comprehensive history, physical examination, screening tools, laboratory testing, and advanced imaging appropriately will help make treatment most efficient.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Martin BI, Deyo RA, Mirza SK, Turner JA, Comstock BA, Hollingworth W, et al. Expenditures and health status among adults with back and neck problems. JAMA. 2008;299(6):656–64.

    Article  CAS  Google Scholar 

  2. Bellan M, Molinari R, Castello L, Sola D, Gibbin A, Guaschino G, et al. Profiling the patients visiting the emergency room for musculoskeletal complaints: characteristics and outcomes. 2016;35(11):2835–9.

  3. Waterman B, Belmont P, Schoenfeld A. Low back pain in the United States: incidence and risk factors. Spine J. 2012;12:63–70.

    Article  Google Scholar 

  4. Maher C, Underwood M, Buchbinder R. Non-specific low back pain. Lancet. 2017;389(10070):736–47.

    Article  Google Scholar 

  5. Nagayama M, Yanagawa Y, Aihara K, Watanabe S, Takemoto M, Nakazato T, et al. Analysis of non-traumatic truncal back pain in patients whovisited an emergency room. Acute Med Surg. 2014;1:94–100.

    Article  Google Scholar 

  6. Enthoven W, Geuze J, Scheele J, Bierma-Zeinstra S, Bueving H, Bohnen A, et al. Prevalence and “Red Flags” regarding. Phys Ther. 2016;96(3):305–12.

    Article  Google Scholar 

  7. Downie A, Williams C, Henschke N, Hancock M, Ostelo RW, de Vet HC, et al. Red flags to screen for malignancy and fracture in patients with low back pain: systematic review. BMJ. 2013;347:f7095.

    Article  Google Scholar 

  8. •• Hill J, Dunn K, Lewis M, Mullis R, Main C, Foster N, et al. A primary care back pain screening tool: identifying patient subgroups for initial treatment. Arthritis Rheum. 2008;59(5):632–41 This screening tool provides a quick and simple way to classify patients as low, medium, and high risk for back pain treatments and response, and includes the psychosocial effect of mood on pain incorporated within the patient questionnaire.

    Article  Google Scholar 

  9. Adizie T, Elamanchi S, Prabu A, Pace AV, Laxminarayan R, Barkham N. Knowledge of features of inflammatory back pain in primary care in the West Midlands: a cross-sectional survey in the United Kingdom. Rheumatol Int. 2018:1–5.

  10. Calin A, Porta J, Fries J, Schurman DJ. Clinical history as a screening test for ankylosing spondylitis. JAMA. 1977;237(24):2613–4.

    Article  CAS  Google Scholar 

  11. Kohns D, Haig A, Uren B, Thompson J, Muraglia KA, Loar S, et al. Clinical predictors of the medical interventions provided to patients with low back pain in the emergency department. J Back Musculoskelet Rehabil. 2018;31(1):197–204.

    Article  Google Scholar 

  12. Chou R, Qaseem A, Owens DK, Shekelle P. Clinical Guidelines Committee of the American College of Physicians: Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians. Ann Intern Med. 2011;154:181–9.

    Article  Google Scholar 

  13. Nagayama M, Yanagawa Y, Aihara K. Analysis of non-traumatic truncal back pain in patients who visited an emergency room. Acute Med Surg. 2014;1(2):94–100.

    Article  Google Scholar 

  14. Ramakrishnan K, Scheid D. Diagnosis and management of acute pyelonephritis in adults. Am Fam Physician. 2005;71(5):933–42.

    PubMed  Google Scholar 

  15. Henschke N, Maher CG, Refshauge KM, Herbert RD, Cumming RG, Bleasel J, et al. Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. Arthritis Rheum. 2009;60(10):3072–80.

    Article  Google Scholar 

  16. Malanga G, Wolff E. Evidence-informed management of chronic low back pain with trigger point injections. Spine J. 2008;8:243–52.

    Article  Google Scholar 

  17. Fernandez-de-las-Penas C, Layton M, Dommerholt J. Dry needling for the management of thoracic spine pain. J Man Manip Ther. 2015;23(3):147–53.

    Article  Google Scholar 

  18. Covington E. Chronic pain management in spine disorders. Neurol Clin. 2007;25(2):539–66.

    Article  Google Scholar 

  19. Abenhaim L, Suissa S. Importance and economic burden of occupational back pain: a study of 2,500 cases representative of Quebec. J Occup Med. 1987;29(8):670–4.

    CAS  PubMed  Google Scholar 

  20. Tunks ER, Crook J, Weir R. Epidemiology of chronic pain with psychological comorbidity: prevalence, risk, course, and prognosis. Can J Psychiatry. 2008;53(4):224–34.

    Article  Google Scholar 

  21. Pergolizzi JV Jr, Raffa RB, Taylor R Jr, Rodriguez G, Nalamachu S, Langley P. A review of duloxetine 60 mg once-daily dosing for the management of diabetic peripheral neuropathic pain, fibromyalgia, and chronic musculoskeletal pain due to chronic osteoarthritis pain and low back pain. Pain Pract. 2013;13:239–52.

    Article  Google Scholar 

  22. Pergolizzi JV Jr, van de Laar M, Langford R, Mellinghoff H, Merchante IM, Nalamachu S, et al. Tramadol/paracetamol fixed-dose combination in the treatment of moderate to severe pain. J Pain Res. 2012;5:327–46.

    Article  CAS  Google Scholar 

  23. Nijs J, Kosek E, Van Oosterwijck J, Meeus M. Dysfunctional endogenous analgesia during exercise in patients with chronic pain: to exercise or not to exercise? Pain Phys. 2012;15:ES205–13.

    Google Scholar 

  24. Soares LG, Martins M, Uchoa R. Intravenous fentanyl for cancer pain: a “fast titration” protocol for the emergency room. J Pain Symptom Manag. 2003;26(3):876–81.

    Article  CAS  Google Scholar 

  25. • Bellan M, Molinari R, Castello L, Sola D, Gibbin A, Guaschino G, et al. Profiling the patients visiting the emergency room for musculoskeletal complaints: characteristics and outcomes. Clin Rheumatol. 2016;35(11):2835–9 This paper evaluates the percentage of acute, subacute, and nonacute causes of spine pain which presents to the emergency room, and estimated that serious conditions requiring emergent care are less than one percent.

    Article  Google Scholar 

  26. Petrack EM, Christopher NC, Kriwinsky J. Pain management in the emergency department: patterns of analgesic utilization. Pediatrics. 1997;99(5):711–4.

    Article  CAS  Google Scholar 

  27. Le May S, Johnston CC, Choiniere M, Fortin C, Kudirka D, Murray L, et al. Pain management practices in a pediatric emergency room (PAMPER) study: interventions with nurses. Pediatr Emerg Care. 2009;25(8):498–503.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI, 48108, USA

    Sarah Money

Authors
  1. Sarah Money
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sarah Money.

Ethics declarations

Conflict of Interest

The author declares that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Pain Management

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Money, S. Spine Pain Management. Curr Emerg Hosp Med Rep 6, 147–151 (2018). https://doi.org/10.1007/s40138-018-0175-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40138-018-0175-4

Keywords

Search

Navigation