Back Pain - Atraumatic

Acute back pain with neurological signs other than single root signs at L5 or S1
Ask advice 
Acute prolapsed disc + unilateral L5 or S1 root signs    
- X-rays are usually not needed  
- Analgesia
- Mobilise as soon as possible with bed rest for as short a period as possible
- Refer to GP
- Occasionally patient may need admission because of severity of symptoms and/or lack of support at home. 
Other acute back pain    
- Analgesia (NSAID + /-paracetamol & codeine) See page 137
- No role for benzodiazepines
- Mobilise as soon as possible.
- Avoid rest if possible. If can’t mobilise, rest for as short a time as possible
- Refer to GP 
Chronic Back Problems
- If no urgent problem, refer to GP
- X-rays are rarely helpful 
Spinal cord compression or Cauda equina syndrome
Suspect in any patient with pain radiating to both legs and /or difficulty urinating.
- Full neurological examination including PR to test sacral sensation and anal tone
- Ask senior ED advice re MRI
- Catheterise if in retention (beware of overflow incontinence)
- Refer orthopaedics 
NB All patients with spinal problems must have full neurological examination