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How emergency physicians approach low back pain: choosing costly options
K C Elam1, D C Cherkin, R A Deyo
1Department of Health Services, University of Washington, Seattle, USA.
The Journal of Emergency Medicine
|March 1, 1995
Summary
Emergency physicians often order unnecessary tests and recommend prolonged bed rest for low back pain, which can increase costs and offer no proven benefit. Most acute low back pain cases resolve with conservative treatment, not extensive diagnostics.
Area of Science:
- Emergency Medicine
- Orthopedics
- Pain Management
Background:
- Low back pain is a frequent emergency department complaint.
- Current diagnostic and treatment approaches by emergency physicians are not well-defined.
Purpose of the Study:
- To investigate emergency physician practices for diagnosing and treating low back pain.
- To identify trends in imaging, consultation, and treatment recommendations.
Main Methods:
- A questionnaire was administered to a national random sample of emergency physicians.
- Physicians responded to three hypothetical low back pain scenarios (acute sciatica, acute non-sciatica, chronic).
- Data collected on diagnostic tests, specialist consultations, and treatment plans.
Main Results:
- High rates of computed tomography (CT) and magnetic resonance imaging (MRI) recommended for acute low back pain.
- Significant rates of specialist consultation requested for all low back pain types.
- Over 75% recommended bed rest (3.5-4.5 days); 16-40% suggested physical therapy for acute cases.
- Referrals to surgical specialists varied by pain type, highest for acute sciatica (81%).
Conclusions:
- Many emergency physicians' diagnostic and treatment strategies for low back pain are excessive and costly.
- Recommended bed rest durations exceed optimal guidelines.
- Physical therapy recommendations for acute cases lack proven benefit.
- Current practices may not align with evidence-based guidelines for low back pain management.