Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-84b7d79bbc-g7rbq Total loading time: 0 Render date: 2024-07-25T10:32:20.480Z Has data issue: false hasContentIssue false

17 - Analgesia for the Emergency Back Pain Patient

from SECTION TWO - ANALGESIA FOR THE EMERGENCY PATIENT

Published online by Cambridge University Press:  03 December 2009

John H. Burton  and
James Miner
By
Donald Jeanmonod
John H. Burton
Affiliation:
Albany Medical College, New York
James Miner
Affiliation:
University of Minnesota
Donald Jeanmonod
Affiliation:
Department of Emergency Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, NY 12208, Email: jeanmod@mail.amc.edu
Get access

Summary

SCOPE OF THE PROBLEM

Acute low back pain is a very common problem that affects 60–80% of adults during their lifetimes. Fifty percent of working-age adults will have at least one episode of low back pain during any given year. At any one point in time, 15–20% of the population will report having low back pain, 1% of the population will be temporarily disabled, and 1% of the U.S. population will be chronically disabled from back pain. This equates to 24.5 million adults in the United States reporting back pain during the year 2000. Low back pain usually starts between age 30 and 50, with the median age of onset at 48 years. Men and women are equally affected by this problem and it crosses all social and racial boundaries. Epidemiologic studies have shown similar prevalence worldwide. Low back pain is second only to upper respiratory problems as the most common symptom-related reason for a physician visit. In 2000, 44 million prescriptions were written for low back pain, including prescriptions for nonsteroidal anti-inflammatory drugs (NSAIDs) (16.5%), COX-2 inhibitors (10%), and muscle relaxants (18.5%).

Low back pain accounts for a huge financial expenditure. Although patients who become disabled owing to low back pain represent less than 5% of those with low back pain problems, they account for up to 60% of the societal costs for this disorder.

Type
Chapter
Information
Emergency Sedation and Pain Management , pp. 109 - 119
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bigos, S, Bowyer, O, Braen, G, et al. Acute low back problems in adults. Clinical practice guideline no. 14. AHCPR Publ no. 95-0642. Rockville, MD: Agency for Health Care Policy and Research, December 1994.Google Scholar
Liu, X, Pietrobon, R, Curtis, LH, Hey, . Prescription of nonsteroidal anti-inflammatory medications and muscle relaxants for low back pain in the United States. Spine 2004;29(23):E531–E537.Google Scholar
Deyo, RA, Weinstein, JN. Low back pain. N Engl J Med 2001;344:363–370.CrossRefGoogle ScholarPubMed
Spengler, DM, Bigos, SJ, Martin, NA, Zeh, J, Fisher, L, Nachemson, A. Back injuries in industry: A retrospective study. I. Overview and cost analysis. Spine 1986;11(3):241–256.CrossRefGoogle ScholarPubMed
O'Malley, AS, DiGiuseppi, C. Counseling to prevent low back pain. U.S. Preventive Services Task Force. Guide to Clinical Preventive Services, 2nd edn, chapter 60. Washington, DC: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, 1996.Google Scholar
Deyo, RA, Rainville, J, Kent, DL. What can the history and physical examination tell us about low back pain?JAMA 1992;268:760–765.CrossRefGoogle ScholarPubMed
Schnitzer, TJ, Ferraro, A, Hunsche, EKong, SX. A comprehensive review of clinical trials on the efficacy and safety of drugs for the treatment of low back pain. J Pain Symptom Manage 2004;28:72–95.CrossRefGoogle ScholarPubMed
Koes, BW, Sholten, RJ, Mans, JM, Boeter, LM. Efficacy of non-steroidal anti-inflammatory drugs for low back pain: A systemic review of randomized clinical trials. Ann Rheum Dis 1997;56:214–223.CrossRefGoogle Scholar
Tulder, MW, Sholten, RJ, Koes, BW, Deyo, RA. Non-steroidal anti-inflammatory drugs for low back pain. A systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine 2000;21:2501–2513.CrossRefGoogle Scholar
Haimovic, IC, Beresford, HR. Dexamethasone is not superior to placebo for treating lumbosacral radicular pain. Neurology 1986;36(12):1593–1594.CrossRefGoogle Scholar
Beebe, FA, Barkin, RL, Barkin, S. A clinical and pharmacologic review of skeletal muscle relaxants for musculoskeletal conditions. Am J Ther 2005;12:151–171.CrossRefGoogle ScholarPubMed
Tulder, MW, Koes, BW, Bouter, LM. Conservative treatment of acute and chronic nonspecific low back pain: A systematic review of randomized controlled trials of the most common interventions. Spine 1997;22:2128–2156.CrossRefGoogle ScholarPubMed
Tudler, MW, Touray, T, Furlan, AD, Solway, S, Bouter, LM. Muscle relaxants for nonspecific low back pain: A systematic review with the framework of the Cochrane Collaboration Back Review Group. Spine 2003;28:1978–1992.Google Scholar
Toth, PP, Urtis, J. Commonly used muscle relaxant therapies for acute low back pain: A review of carisoprodol, cyclobenzoprine hydrochloride, and metaxalone. Clin Ther 2004;26:1355–1367.CrossRefGoogle ScholarPubMed
Browning, R, Jackson, JL, O'Malley, PG. Cyclobenzoprine and low back pain. A meta-analysis. Arch Intern Med 2001;161:1613–1620.CrossRefGoogle Scholar
Borenstein, DG, Korn, S. Efficacy of a low-dose regimen of cyclobenzoprine hydrochloride in acute muscle spasm: Results of two placebo controlled trials. Clin Ther 2003;25:1056–1073.CrossRefGoogle ScholarPubMed
O'Connor, AB, Lang, VJ, Quill, TE. Underdosing of morphine compared to other parenteral opiates in an acute hospital: A quality of care challenge. Pain Med 2006;7:299–307.CrossRefGoogle Scholar
Finckh, A, Zufferey, P, Schurch, MA, Balague, F, Waldburger, MSo, AK. Short-term efficacy of intravenous pulse glucocorticoids in acute discogenic sciatica. A randomized controlled trial. Spine 2006;31:377–381.CrossRefGoogle ScholarPubMed
Staiger, TO, Gaster, B, Sullivan, MD, Deyo, RA. Systematic review of anti-depressants in the treatment of chronic low back pain. Spine 2003;28:2540–2545.CrossRefGoogle Scholar
French, SD, Cameron, M, Walker, BF, Reggars, JW, Esterman, AJ. Superficial heat or cold for low back pain. A Cochrane review. Cochrane Libr 2006;4750:3.Google Scholar
Machado, Souza, MS, Ferreira, PH, Ferreira, ML. The McKenzie method for low back pain: A systematic review of the literature with a meta-analysis approach. Spine 2006;31:E254–E262.CrossRefGoogle ScholarPubMed
Hayden, JATulder, MW, Malmivaara, AV, Koes, BW. Meta-analysis: Exercise therapy for nonspecific low back pain. Ann Intern Med 2005;142:765–775.CrossRefGoogle ScholarPubMed
Hagen, KB, Jamtvedt, G, Hilde, G, Winnem, MF. The updated Cochrane review of bed rest for low back pain and sciatica. Spine 2005;30:542–546.CrossRefGoogle ScholarPubMed
Assendelft, WJJ, Morton, SC, Emily, Yu, , I, Suttorp, MJ, Shekelle, PG. Spinal manipulative therapy for low-back pain. A Cochrane review. Cochrane Libr 2006;447:3.Google Scholar
Nelemans, PJ, diBie, RA, deVet, HC, Sturmans, F. Injection therapy for subacute and chronic benign low back pain. Spine 2001;26:501–515.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×