Today in Morning Report we reviewed a case of a 60F with acute onset of low back pain.
Remember the Red Flags of Back Pain:
1. Saddle anesthesia
2. Bowel/bladder changes
3. Constitutional symptoms (fever, chills, sweat, anorexia, weight loss)
4. Prior or current history of malignancy
5. Night pain
6. Hx of IVDU
7. Older age> 65 with new onset back pain
Why do we care about these red flags?
- Impending neurologic compromise
- Malignancy
- Abscess
The role of imaging in the management of low back pain: bottom line - in the absence of red flags, imaging for LBP doesn't significantly influence management and is associated with substantial cost.
http://www.ncbi.nlm.nih.gov.myaccess.library.utoronto.ca/pubmed/15031430 (use your UtorID for access)
A systematic review published in the Annals of Internal Medicine in 2004 concluded that in adults < 50 years old with no systemic symptoms (or red flags), symptomatic therapy without imaging is appropriate. In adults > 50 years, or those with systemic symptoms, routine bloodwork and plain radiographs are usually sufficient to rule out underlying systemic disease.
http://www.ncbi.nlm.nih.gov.myaccess.library.utoronto.ca/pubmed/12353946
