ED Back Pain pathway

LBP is the leading cause of disability in Western countries. It is in the top 5 of most common presentations to ED. Approximately 25% of cases that present to ED will have another episode of LBP and potentially represent to ED within 1 year.

The back pain pathway is an initiative developed for patients under 65 years old suffering from lower back pain who have attended MMUH ED when severe pathologies have been ruled out, the main on being malignancy, infection or Cauda equina syndrome.

The forms can be found on Mater Patient Documents under the ED back pain pathway tab.

The STarT Back tool is used to stratify low, medium to high risk patients. Use of StaRt back stratification tool to ensure patient’s care plan is appropriate for their needs.

Those with moderate risk with/without sciatica and low risk with sciatica referred directly to physiotherapy

Consider referral for nerve block/epidural for those with low/moderate risk with sciatica

Those considered high risk referred directly to Pain clinic

Do not offer gabapentinoids, ant-epileptics, oral corticosteroids or benzodiazepines for management of sciatica (NICE 2020)

Patient education leaflets (separate LBP and sciatica leaflets now available on pc) now updated and to be given to all patients.

If MRI Lumbar spine is indicated please discuss with the ED consultant.

The clinic allows referral of patients to appropriate follow-up:

  • Low/medium risk with or without sciatica and symptoms of up to 6 weeks from onset to ED physiotherapy- anything greater GP to organize community physiotherapy

  • High risk patients will require referral to pain services from ED, GP to organize community physiotherapy.

  • In the case of high risk patients with sciatic symptoms request MRI lumbosacral and discuss with ED consultant.

  • Appropriate analgesia and patient education required for all.

All patients referred are automatically given a face to face appointment.

Remember to:

  • Put the STarT Back score on the referral

  • Give the patients acute LBP and sciatica information leaflets as appropriate

  • Refer directly to the pain clinic for injection when appropriate

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