3.6. BACK PAIN

Related Names

None.

Purpose of assistance

1. Improve patient comfort.
2. Identify life-threatening underlying causes of back pain.

Patient description

Inclusion criteria

Back pain or discomfort of non-traumatic origin or back pain due to non-severe trauma (for example, chronic pain).

Exclusion criteria

1. Back pain due to spinal injury (see instructions of the “Injury” section).
2. Back pain due to sickle cell crisis (see instruction “Pain in sickle cell crisis”).
3. Back pain is associated with childbirth (see instructions of the section “Obstetrics/Gynecology”).

Patient Management

Condition assessment

1. Perform airway inspection and control according to the Airway Control guideline.

2. Determine vital signs including pulse, respiratory rate, pulse oximetry, blood pressure.

3. Assess and control pain according to the “Pain Control” guideline.

4. Access the vein (if necessary) for pain relief and infusion therapy.

5. Assess the presence of life-threatening underlying causes of back pain:

a) spinal cord compression (e.g. due to spinal epidural abscess, presence of malignancies, spinal epidural hematoma in patients taking anticoagulants):

• • • • incontinence and feces;
      • inability to move due to weakness;
      • new neurological disorders in the limbs;
      • loss of sensation in the lower body;

b) aortic tear or rupture of the abdominal aortic aneurysm:

• • • • unequal pulse on the hips and distal parts of the lower extremities;
      • “pulsating” abdominal mass;
      • irradiation of abdominal and/or chest pain;
      • history of aortic aneurysm;

c) pyelonephritis:

• • • • fever;
      • nausea, vomiting;
      • urinary diuresis/incontinence rate;
      • dysuria;
      • hematuria;
      • abdominal pain;
      • sensitivity of the costovertebral angle during percussion.

6. Assess for signs of shock. If there is shock, treat according to the “Shock” guideline.

7. Evaluate other, non-life-threatening causes of abdominal pain.
Kidney stones:

a) unilateral pain in the side;
b) nausea, vomiting;
c) hematuria is possible;
d) history of kidney stones.

Treatment and intervention

Introduction of drugs.

1. Perform anesthesia according to the instruction “Pain Control.”
2. Inject anticonvulsants according to the “Nausea/Vomiting” guideline.
3. Transport the patient to the appropriate department – transportation to highly specialized departments may be required.
4. Re-evaluate vital signs and response to therapeutic interventions during transport.

Patient safety

No recommendations

Useful information for training

Key points

1. Assess for life-threatening underlying causes of back pain.
2. Provide appropriate care for pain, nausea and shock.
3. If you suspect an aortic aneurysm, take care of transporting the patient to the appropriate emergency room.
4. Pain in the abdomen and back can simultaneously exist, while having the same picture of the course of diseases.
5. Determine whether the patient is taking anticoagulant drugs, as they have a high risk of spinal epidural hematoma or retroperitonal bleeding, which can manifest as back pain.
6. Identify patients with a history of injectable drug use and/or impaired immunity as they have a higher risk of spinal epidural abscess.
7. Identify patients with a history of cancer or suspected cancer – metastases to the spine can cause spinal cord compression.

1.  
2. Sensitivity in the back along the midline.
3. Swelling or erythema on the back.
4. Loss of motor function and/or sensitivity in the limbs.
5. Loss of perinatal sensitivity.
6. Absence or serious difference in pulse on the femoral and distal arteries of the lower limbs.
7. Hyper- or hypothermia.
8. Rectal bleeding or hematemesis.

Key elements of documentation

1. Assessment of the back and abdomen including palpation/percussion results including presence or absence of masses and presence and nature of sensitivity/pain.
2. Assessment of primary neurological status and its changes.
3. Evaluation of primary perfusion/pulse and its changes.

Criteria for the effectiveness of care

1. Evaluation of life-threatening conditions.
2. Pain reduction according to the instruction “Pain control.”