In the emergency department (ED), low back pain is one of the most common musculoskeletal chief complaints and affects approximately 80% of adults at some point in their lives.1
The complaint of low back pain was responsible for approximately 4% of ED visits from 2000 to 2016.2
“Spinal conditions,” which include neck and back pain, comprise the third largest portion of total national health spending in the United States, behind diabetes and heart disease.3
The majority of patients presenting to the ED will complain of neck or lower back pain rather than thoracic-level pain. Thoracic back pain has been documented less frequently, with < 20% of people reporting symptoms within their lifetime.4
Many will have benign etiologies that will resolve with conservative management, but the small percentage that requires immediate intervention must be quickly identified. In addition, patients with nonemergent conditions require a well-thought out strategic plan to manage their condition and maximize function.
A broad differential diagnosis and an evaluation that is systematic without bias is fundamental to managing low back pain; see Table 14.1
. In addition to primary spinal pathology, processes that may refer pain to the back must be considered. Failure to address these alternative diagnoses in the face of localized pain is a common oversight in many case reviews.5
Because of the lower frequency of thoracic back pain, vascular emergencies and other causes of referred pain must remain high on the differential for patients with this complaint.