Evidence-based imaging for the management of lower back pain in the emergency department: A narrative review

Submitted: 16 February 2022
Accepted: 14 June 2022
Published: 27 June 2022
Abstract Views: 2044
PDF: 317
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Patients often present to the emergency department with nonspecific complaints of lumbar back pain. Because of the nature of the emergency department, the lack of knowledge or time on the part of providers, and the high levels of quick decision making, unnecessary imaging studies are often ordered to provide care for the patient’s emotional and perceived physical needs. This narrative review will present a hypothetical typical standardized case of a patient presenting with lower back pain, examine the current evidence and recommendations from the major ruling bodies in internal medicine, neurology, neurosurgery, and radiology, evaluate the major statements released by the Choosing Wisely campaign, and finally, present a new diagnostic decision tree for the management of lumbar back pain.

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Wu A, March L, Zheng X, et al. Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017. Ann Transl Med 2020;8:299. DOI: https://doi.org/10.21037/atm.2020.02.175
Idil H, Kilic TY, Toker İ, et al. Non-urgent adult patients in the emergency department: Causes and patient characteristics. Turkish J Emerg Med 2018;18:71–4. DOI: https://doi.org/10.1016/j.tjem.2017.10.002
Hoy D, March L, Brooks P, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 2014;73:968–74. DOI: https://doi.org/10.1136/annrheumdis-2013-204428
Hartvingsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention. Lancet 2015;386:2145-91.
Siu VJ, Varkey T, Khan UN, et al. Lend Me a Hand: A Value-Based Care Case Study on Pan Plexopathy of Unknown Origin. Cureus 2021;13:e20354. DOI: https://doi.org/10.7759/cureus.20354
Kao AC, Green DC, Davis NA, et al. Patients' trust in their physicians: effects of choice, continuity, and payment method. J General Intern Med 1998;13:681–6. DOI: https://doi.org/10.1046/j.1525-1497.1998.00204.x
Classen DC, Kilbridge PM. The roles and responsibility of physicians to improve patient safety within health care delivery systems. Acad Med 2002;77:963-72. DOI: https://doi.org/10.1097/00001888-200210000-00007
Finucane LM, Downie A, Mercer C, et al. International framework for red flags for potential serious spinal pathologies. J Orth Sports Phys Ther 2020;50:350-72. DOI: https://doi.org/10.2519/jospt.2020.9971
Deyo RA, Weinstein JN. Low back pain. N Engl J Med 2001;344:363-70. DOI: https://doi.org/10.1056/NEJM200102013440508
Joines JD, McNutt RA, Carey TS, et al. Finding cancer in primary care outpatients with low back pain: a comparison of diagnostic strategies. J General Intern Med 2001;16:14–23. DOI: https://doi.org/10.1111/j.1525-1497.2001.00249.x
Jarvik JG, Deyo RA. Diagnostic evaluation of low back pain with emphasis on imaging. Ann Intern Med 2002;137:586-97. DOI: https://doi.org/10.7326/0003-4819-137-7-200210010-00010
Sandhu HS, Sanchez-Caso LP, Parvataneni HK, et al. Association between findings of provocative discography and vertebral endplate signal changes as seen on MRI. J Spinal Disord 2000;13:438-43. DOI: https://doi.org/10.1097/00002517-200010000-00012
Pui MH, Husen YA. Value of magnetic resonance myelography in the diagnosis of disc herniation and spinal stenosis. Australas Radiol 2000;44:281-4. DOI: https://doi.org/10.1046/j.1440-1673.2000.00813.x
Chou R, Qaseem A, Snow V, et al Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007;147:478-91. DOI: https://doi.org/10.7326/0003-4819-147-7-200710020-00006
Bussieres AE, Taylor JA, Peterson C. Diagnostic imaging practice guidelines for musculoskeletal complaints in adults -an evidence-based approach part 3: spinal disorders. J Manipulative Physiol Ther 2008;31:33-88. DOI: https://doi.org/10.1016/j.jmpt.2007.11.003
Reed SJ, Pearsons S. Choosing wisely® recommendation analysis: Prioritizing opportunities for reducing inappropriate care. Imaging for nonspecific low back pain. 2019. Accessed February 9, 2022. Available from: https://www.choosingwisely.org/wp-content/uploads/2015/05/ICER_Low-Back-Pain.pdf
Foundation, A. B. I. M. ACEP - Lumbar Spine Imaging in the ED: Choosing wisely. Choosing Wisely | Promoting conversations between providers and patients. 2015, November 9. Retrieved February 9, 2022. Available from: https://www.choosingwisely.org/clinician-lists/acep-lumbar-spine-imaging-in-the-ed/
Foundation, A. B. I. M. Imaging tests for back pain: Choosing wisely. Choosing Wisely | Promoting conversations between providers and patients. 2018, October 31. Retrieved February 9, 2022. Available from: https://www.choosingwisely.org/patient-resources/imaging-tests-for-back-pain/
Foundation, A. B. I. M. Low back pain: Choosing wisely. Choosing Wisely | Promoting conversations between providers and patients. 2019, June 21. Retrieved February 9, 2022. Available from: https://www.choosingwisely.org/patient-resources/low-back-pain/
Brady AP, Bello JA, Derchi LE, et al. Radiology in the era of value-based healthcare: A multi-society expert statement from the ACR, CAR, ESR, IS3R, RANZCR, and RSNA. Can Assoc Radiol J 2021;72:208-14. DOI: https://doi.org/10.1177/0846537120982567
European Society of Radiology (ESR). ESR concept paper on value-based radiology. Insights Imaging 2017;8:447–54. DOI: https://doi.org/10.1007/s13244-017-0566-1
Epstein RM, Street RL, Jr. The values and value of patient-centered care. Ann Fam Med 2011;9:100–3. DOI: https://doi.org/10.1370/afm.1239
Khalil TM, Asfour SS, Martinez LM, et al. Stretching in the rehabilitation of low-back pain patients. Spine (Phila Pa 1976) 1992;17:311-7. DOI: https://doi.org/10.1097/00007632-199203000-00012
Rainville J, Hartigan C, Martinez E, et al. Exercise as a treatment for chronic low back pain. Spine J 2004;4:106-15. DOI: https://doi.org/10.1016/S1529-9430(03)00174-8
Kamal KC, Alexandru DO, Kamal D, et al. Managing low back pain in primary care. Curr Health Sci J 2020;46:396-404.
Visser S, van der Molen HF, Kuijer PP, et al. Evaluation of team lifting on work demands, workload and workers' evaluation: an observational field study. Appl Ergon 2014;45:1597-602. DOI: https://doi.org/10.1016/j.apergo.2014.05.009
Faber G, Visser S, van der Molen HF, et al. Does team lifting increase the variability in peak lumbar compression in ironworkers? Work 2012;41:4171-3. DOI: https://doi.org/10.3233/WOR-2012-0714-4171
Hudon C, Fortin M, Haggerty JL, et al. Measuring patients' perceptions of patient-centered care: a systematic review of tools for family medicine. Ann Fam Med 2011;9:155–64. DOI: https://doi.org/10.1370/afm.1226
Epstein RM, Franks P, Fiscella K, et al. Measuring patient-centered communication in patient-physician consultations: Theoretical and practical issues. Soc Sci Med 2005;61:1516-28. DOI: https://doi.org/10.1016/j.socscimed.2005.02.001

How to Cite

Akkihal, K., Adams, E. C., Khan, S., Jafri, F., Taboada, J., & Varkey, T. (2022). Evidence-based imaging for the management of lower back pain in the emergency department: A narrative review. Emergency Care Journal, 18(2). https://doi.org/10.4081/ecj.2022.10413