Spine Pain Management

Autor: Sarah Money
Rok vydání: 2018
Předmět:
Zdroj: Current Emergency and Hospital Medicine Reports. 6:147-151
ISSN: 2167-4884
Popis: Spine pain is one of the most common complaints presenting to the emergency department and represents significant healthcare cost. Evaluation and workup of these patients can be difficult, and a proper history and physical exam will minimize unnecessary tests. Nontraumatic spine pain is most often idiopathic or related to muscle or ligamentous strain. Although musculoskeletal mechanisms are most commonly responsible, there are very rarely, but importantly, life-threatening conditions which present as spine pain, and these must be ruled out. The presence of neurologic deficit renders advanced imaging and neurosurgical consultation necessary. A subset of spine pain seen in the emergency department is chronic pain, and these cases require the full spectrum of pain management in order to address the associated symptoms which contribute to pain, and this can often be done in the outpatient setting. There is a positive correlation between psychological distress, insomnia, and depression with chronic pain. Efficiency is paramount in the emergency department, and simple screening tools such as the STarT Back Screening tool can be used to estimate prognosis in spine pain. Once a diagnosis is made, one can determine which pharmacologic treatment, if any, is necessary. Nonopioid, anti-inflammatory pain medications are most appropriate to treat acute inflammatory pain. Alternatively, cancer spine pain may require very high-dose opioids to adequately address pain crises, and chronic pain may require medications such as anti-convulsants, anti-depressants, or even atypical anti-psychotics. There is no perfect method for evaluating and diagnosing spine pain, however utilizing the comprehensive history, physical examination, screening tools, laboratory testing, and advanced imaging appropriately will help make treatment most efficient.
Databáze: OpenAIRE
Externí odkaz: