Definition

Lower back pain and/or sciatica with no neurological defi cits

The main risks when admitting someone with back pain to SSOU are that the patient will be impossible to discharge (especially if they have been given unrealistic expectations about what can be acheived for their pain during hte admission) or that we admit for symptomatic management someone with a more serious condition that leads to permanent neurological deficit. Diagnoses of concern include traumatic spinal injury, malignancy, epidural abscess/discitis/osteomyelitis and cauda equina syndrome. 

Admission Criteria

• Medical and physio assessment indicates discharge within 24 hrs likely
• Episode has
• History of back pain responsive to treatment

Exclusion Criteria

• Chronic back pain
• Previous prolonged admission for acute back pain
• Previous back surgery
• Refusing to take analgesia
• Multiple drug intolerances
• Fever without clear cause
• Unable to complete ADLS (prior to acute pain)
• ANY neurological signs, sphincter disturbance, or urinary retention
• requiring more than 2 doses of Morphine in the ED

Any red flags

• Significant recent trauma
• Age under 20 or over 50
• Unexplained weight loss
• Immunosuppresant therapy
• Malignancy
• Steroid or IV drug use

Investigations

Required

• Urinalysis

Additional as indicated

• Plain Xray (elderly, low fall, increasingly replaced with CT now
• ESR, CRP, WCC
• CT especially in trauma including low falls
• MRI

Suggested Medications

Specific Observations report immediately to medical staff any of the following

• Report bowel or bladder disturbances eg incontinence or acute urinary retentionr
• Report any new weakness or numbness in legs or progression of symptoms
• Report fever
• Observe conscious state and withhold opiate analgesia if drowsy or asleep but give other medications

Specific Management Issues

• Encourage mobilisation and give regular analgesia strictly plus any PRN requested
• Report unremitting pain for medical review of diagnosis and analgesia regime
• Regular physiotherapy review
• Neurosurgery if ANY neurological or bowel or bladder disturbance develops

Discharge Criteria

• Responsible carer
• Follow-up physio arrangements made
• Able to ambulate and pain controlled (unlikely to be pain free on discharge)
• Able to void

Hospital Admission Criteria

• Neurological signs
• Uncontrolled pain
• Inability to take oral medication
• Unable to walk to toilet
• Unable to establish safe environment