Episode 206: Acute Back Pain

Emergency physician Dr. Ben Friedman joins Brian Gilberti to discuss the evaluation and management of acute back pain in the emergency department. The conversation emphasizes differentiating between benign musculoskeletal issues and serious pathologies like spinal infections, bleeds, or lesions, primarily through detailed history and focused neurological exams. Imaging, especially lumbar x-rays, is discouraged for young, healthy patients without specific risk factors or neurological deficits, while MRI is reserved for high-risk cases. The discussion highlights that NSAIDs and skeletal muscle relaxants are the only medications with proven benefits, while acetaminophen, opioids, and steroids for non-radicular pain are generally ineffective. The importance of non-pharmacologic treatments like yoga and physical therapy, along with patient involvement in their care, is underscored.