Approach to acute low back pain in the emergency unit for treatment decision making

To differentiate neuropathic and nonspecific low back pain by clinical examination, determine correlation of radiological lesions with clinical signs and impact treatment decisions. A 4 month prospective ongoing study was carried out in the Emergency unit at Pauls Stradins Clinical University Hospital. Patients presented with LBP were included. Patients filled questionnaires and were assessed clinically.  Standardized Evaluation of Pain (StEP). was used to distinguish neuropathic and non-neuropathic low back pain.Patients were categorised into neuropathic/non-neuropathic and specific pain groups. After up to 90 days patients were followed up. A total of 37 patients were evaluated: 16 females ( 43,2%) and 21 males (56,8%), median age - 47 years (27–78 ± 13). After a detailed examination 27 patients (73%) were determined to have non-neuropathic pain, 6 patients (16,2%) - neuropathic pain, 3 patients (8,1%) had a specific disease. In 19 patients (51,4%) visual diagnostics were done in the emergency unit, but more patients received additional radiological investigations later. Overall 75% (n=28) of study participants received radiological imaging. Radiologic examination impacted treatment for only 2 patients. One patient developed spondylodiscitis. One patient with non specific low back pain was found to have a fracture of sacrum. StEP scale confirmed radicular pain in 6 out of 11 patients and correlated with radiological lesions. Our study demonstrates non-specific LBP as a leading cause of emergency admission due to back pain. Even in the absence of red flags, careful follow up is important in patients with non remitting back pain. Further investigation is needed to determine impact of radiological investigations on patient's outcomes.