Back Pain

Key Questions |
Prior History Name, Age, Onset, Cause, Location, Medications, Pain Scale,

Other Protocols to Consider | Abdominal Pain, Adult; Back/Neck Injury; Chest

Pain; Numbness and Tingling; Pregnancy Problems; Urination, Painful; Urine, Abnormal Color; Weakness.
Reminder: Document caller response to advice, home care instructions, and when to call back.
ASSESSMENT A. Are any of the following present? ACTION

Progressive weakness in legs New sudden onset of numbness or tingling in legs or feet or loss of bladder or bowel control New onset of numbness in groin or rectal area New onset, rapidly increasing pain, and age > 60 years Dizziness, lightheadedness, or abdominal fullness Inability to urinate for > 8 hours Cool, moist skin Pain radiates to neck, shoulders, jaw, or arm
B. Are any of the following present?

YES

Seek emergency care now See Back/Neck Injury protocol if recent back injury or traumatic accident has occurred Go to B

NO

YES NO

Seek medical care immediately Go to C

Severe pain with blood in the urine Difficulty moving legs, feet, or toes Fever with nausea or vomiting in a female Sudden pain after a prolonged period of time in bed or a wheelchair, or if > age 60 years New onset, rapidly increasing pain, and age < 60 years Pain radiates to groin or genitals

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Back Pain

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C. Are any of the following present?

Pain radiates to buttocks or limbs Persistent severe pain Frequent urination or pain with urination Some difficulty walking because of discomfort No relief with OTC medications Fever with nausea or vomiting in a male History of trauma > 48 hours History of diabetes, a weakened immune system, or steroid use History of cancer or unexplained weight loss Intravenous drug abuse Pain worse at night or when lying down Blisters or rash and pain in same area Persistent loss of bowel or bladder control Persistent numbness or tingling in legs or feet

YES

Seek medical care within 24 hours Go to D

NO

D. Are any of the following present?

History of chronic back pain, back problems, back surgery, kidney stones, or renal disease Mild pain without radiation or limited movement Fever with flulike symptoms

YES

Call back or call PCP for appoint- ment if no improvement and Follow Home Care Instructions Follow Home Care Instructions

NO

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Back Pain

Home Care Instructions

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Back Pain

Restrict to light activities for 2 to 3 days. Use a firm mattress or place a board under a soft mattress. Avoid activities such as prolonged sitting, lifting, or jumping until the pain is resolved (do not stay bed). Take your usual pain medication for discomfort. Do not give aspirin to a child. Avoid aspirinlike products if age < 20 years old. Avoid acetaminophen if liver disease is present. Avoid ibuprofen if kidney disease or stomach problems exist or in the case of pregnancy. Follow the directions on the label. If pain is related to an injury, apply ice packs for the first 24 hours, then moist heat. Use moist heat (shower, tub, or moist hot towels) for 20 to 30 minutes every 2 hours for 48 hours, but only while person is awake. Sleep in a fetal position or on the back with one to two pillows under the knees to help reduce discomfort. For intermittent or chronic back discomfort, use a heating pad on the affected area 20 to 30 minutes every 2 to 4 hours. Do not sleep on a heating pad. Do not apply heating pad directly to the skin without a cloth barrier between heating pad and skin.
Additional Instructions

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Report the Following Problems to Your PCP/Clinic/ED

No improvement in 3 days Pain worsens Pain radiates into a limb, groin, or genitals Painful urination, frequent urination, fever, or blood in the urine

Seek Emergency Care Immediately If Any of the Following Occur

New onset of persistent numbness or tingling in legs or feet, or loss of bowel or bladder control,
or inability to urinate for > 8 hours

Weakness in the limbs New-onset cool, moist skin, or pain radiates to neck, shoulders, jaw, or arm

If the caller agrees with the advice given, document the call and encourage the caller to call back or see PCP if the problem worsens. If the caller does not agree with the advice given, reevaluate and advise the caller to follow up with PCP, Clinic, or ED.