Low Back Pain

Emergency department management of low back pain requires distinguishing between benign mechanical issues and rare but life-threatening pathologies like spinal epidural abscesses or cauda equina syndrome. While back pain accounts for approximately 4.4% of emergency visits, the incidence of serious underlying conditions is significantly higher in the ED than in primary care settings. Clinical assessment relies on identifying specific red flags, such as neurological deficits, bowel or bladder dysfunction, and immunocompromised states, rather than relying on isolated symptoms. Diagnostic imaging, particularly MRI, remains the gold standard for suspected serious pathology, as plain films and CT scans often lack the sensitivity required to detect disc herniation or cord compression. Pharmacologic interventions, including opioids and muscle relaxants, offer limited evidence of efficacy and carry risks of adverse effects, making targeted physical therapy a more effective, evidence-based approach for long-term recovery.