Profile and management of patients with low back pain complaints in a Brazilian Emergency Department: a cross-sectional retrospective study

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Larissa Faria Borges
Ligia Loiola Cisneros
https://orcid.org/0000-0002-9940-2119
Danielle Aquino Silva
Amabile Borges Dario
Manuela Ferreira
Paulo Henrique Ferreira

Abstract

Objective: To describe the demographic profile and the management of patients with low back pain (LBP) complaints presenting to the Emergency Department (ED) of a Brazilian public hospital. Methods: Retrospective, cross-sectional study using a convenience sample of patients with LBP triaged at the studied ED through the Manchester Triage System along a year. Data were extracted from electronic medical records. LBP presentations were classified as non-traumatic, traumatic, and non-spinal related pain according to the signs and symptoms reported. Data included patients’ demographic profile, pain severity and management (e.g., imaging exams, medication prescription and hospitalization). Results: Data from 2016 patients was analyzed. Most were middle-aged adults (mean age = 40.5years, SD 15.7), female (n = 1043, 51.7%) and presented moderate pain intensity (score range 4 to 7 on the Visual Analogue Scale, n=1,471; 74.1%). Non-traumatic pain (n = 1,016; 50.4%) was the main cause of care-seeking. A total of 36.9% (n = 743) underwent imaging exams and 42.2% (n = 850) received medication. Patients with non-spinal related pain were three times more likely to receive opioid medication (OR = 2.96; 95%CI 2.30 to 3.79). Conclusion: Non-traumatic LBP (i.e., no history of trauma or red flags) was the main cause of LBP care-seeking in a Brazilian ED. Most patients were treated conservatively and without hospitalization. Opioids prescription and imaging exams, although performed on a smaller scale, were still used for of the management of this type of LBP. 



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1.
Borges LF, Cisneros LL, Silva DA, Borges Dario A, Ferreira M, Ferreira PH. Profile and management of patients with low back pain complaints in a Brazilian Emergency Department: a cross-sectional retrospective study. HSJ [Internet]. 2020 Aug. 29 [cited 2024 Nov. 14];10(3):70-7. Available from: https://portalrcs.hcitajuba.org.br/index.php/rcsfmit_zero/article/view/953
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ORIGINAL ARTICLE

References

Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, et al. What low back pain is and why we need to pay attention. Lancet. 2018;391(10137):2356-67. Doi: 10.1016/S0140-6736(18)30480-X

Dionne CE, Dunn KM, Croft PR, Nachemson AL, Buchbinder R, Walker BF, et al. A consensus approach toward the standardization of back pain definitions for use in prevalence studies. Spine. 2008;33(1):95-103. doi: 10.1097/BRS.0b013e31815e7f94

Garcia JBS, Hernandez-Castro JJ, Nunez RG, Pazos MAR, Aguirre JO, Jreige A, et al. Prevalence of low back pain in Latin America: a systematic literature review. Pain physician [Internet]. 2014[cited 2020 Ago 01];17:379-91. Available from: www.painphysicianjournal.com/current/pdf?article=MjE1NQ==&journal=84

Taylor JB, Goode AP, George SZ, Cook CE. Incidence and risk factors for first-time incident low back pain: a systematic review and meta-analysis. Spine J. 2014;14(10):2299-319. doi: 10.1016/j.spinee.2014.01.026

Hoy D, Brooks P, Blyth F, Buchbinder R. The epidemiology of low back pain. Best Pract Res Clin Rheumatol. 2010;24(6):769-81. doi: 10.1016/j.berh.2010.10.002

Lemeunier N, Leboeuf-Yde C, Gagey O. The natural course of low back pain: a systematic critical literature review. Chiropr Man Therap. 2012;20(1):33. doi: 10.1186/2045-709X-20-33

GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1211-59. doi: 10.1016/S0140-6736(17)32154-2

Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012;64(6):2028-37. Doi: 10.1002/art.34347

Koes BW, van Tulder M, Lin C-WC, Macedo LG, McAuley J, Maher C. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J. 2010;19(12):2075-94. doi: 10.1007/s00586-010-1502-y

Nunn ML, Hayden JA, Magee K. Current management practices for patients presenting with low back pain to a large emergency department in Canada. BMC Musculoskelet Disord. 2017;18(1):92. doi: 10.1186/s12891-017-1452-1

Waterman BR, Belmont PJ, Schoenfeld AJ. Low back pain in the United States: incidence and risk factors for presentation in the emergency setting. Spine J. 2012;12(1):63-70. doi: 10.1016/j.spinee.2011.09.002

Edwards J. The prevalence of low back pain in the emergency department: A systematic review and primary study in the Charles V. Keating Emergency and Trauma Centre [Master Dissertation]. Halifax: Dalhousie University; 2016 [cited 2020 Ago 02]. Available from: dalspace.library.dal.ca/bitstream/handle/10222/72160/Edwards-Jordan-MSc-CHE-August-2016.pdf?sequence=1

Kocher KE, Meurer WJ, Fazel R, Scott PA, Krumholz HM, Nallamothu BK. National trends in use of computed tomography in the emergency department. Ann Emerg Med. 2011;58(5):452-62.e3. doi: 10.1016/j.annemergmed.2011.05.020

Canadian Institute for Health Information. A snapshot of health care in Canada as demonstrated by top 10 Lists. Ottawa, Ont: CIHI; 2012 [cited 2020 Ago 02]. Available from: secure.cihi.ca/free_products/Top10ReportEN-Web.pdf

Ferreira G, Costa LM, Stein A, Hartvigsen J, Buchbinder R, Maher CG. Tackling low back pain in Brazil: a wake-up call. Braz J Phys Ther. 2019;23(3):189-95. doi: 10.1016/j.bjpt.2018.10.001

Galliker G, Scherer DE, Trippolini MA, Rasmussen-Barr E, LoMartire R, Wertli MM. Low back pain in the emergency department: prevalence of serious spinal pathologies and diagnostic accuracy of red flags. Am J Med. 2020;133(1):60-72.e14. doi: 10.1016/j.amjmed.2019.06.005

Parenti N, Reggiani MLB, Iannone P, Percudani D, Dowding D. A systematic review on the validity and reliability of an emergency department triage scale, the Manchester Triage System. Int J Nurs Stud. 2014;51(7):1062-9. doi: 10.1016/j.ijnurstu.2014.01.013

Azeredo TRM, Guedes HM, de Almeida RAR, Chianca TCM, Martins JCA. Efficacy of the Manchester Triage System: a systematic review. Int Emerg Nurs. 2015;23(2):47-52. Doi: 10.1016/j.ienj.2014.06.001

Anziliero F, Soler D, Elis B, Silva BAd, Tanccini T, Beghetto MG. Manchester System: time spent on risk classification and priority of care at an emergency medical service. Revista gaucha de enfermagem. 2016;37(4):e64753. doi: 10.1590/1983-1447.2016.04.64753

da Costa JSM. Serviços de urgência e emergência hospitalar: atendimento não urgente nas redes de atenção às urgências, num contexto de transformações demográficas [PhD Thesis]. Belo Horizonte: Universidade Federal de Minas Gerais; 2011 [cited 2020 Ago 02]. Available from: repositorio.ufmg.br/handle/1843/AMSA-8UYQ59

McCormack HM, David JdL, Sheather S. Clinical applications of visual analogue scales: a critical review. Psychol Med. 1988;18(4):1007-19. doi: 10.1017/S0033291700009934

World Health Organization (WHO) [Internet]. WHO’s cancer pain ladder for adults. Geneva: WHO; 2016 [cited 2020 Ago 02]. Available from: www.who.int/cancer/palliative/painladder/en

Junqueira D, Ferreira M, Refshauge K, Maher C, Hopper J, Hancock M, et al. Heritability and lifestyle factors in chronic low back pain: results of the Australian Twin Low Back Pain Study (The AUTBACK study). Eur J Pain. 2014;18(10):1410-8. doi: 10.1002/ejp.506

Edwards J, Hayden J, Asbridge M, Gregoire B, Magee K. Prevalence of low back pain in emergency settings: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2017;18(1):143. doi: 10.1186/s12891-017-1511-7

Buchbinder R, van Tulder M, Öberg B, Costa LM, Woolf A, Schoene M, et al. Low back pain: a call for action. Lancet. 2018;391(10137):2384-8. doi: 10.1016/S0140-6736(18)30488-4

Edwards J, Hayden J, Asbridge M, Magee K. The prevalence of low back pain in the emergency department: a descriptive study set in the Charles V. Keating Emergency and Trauma Centre, Halifax, Nova Scotia, Canada. BMC Musculoskelet Disord. 2018;19(1):306. doi: 10.1186/s12891-018-2237-x

Friedman BW, Chilstrom M, Bijur PE, Gallagher EJ. Diagnostic testing and treatment of low back pain in US emergency departments. A national perspective. Spine (Phila Pa 1976). 2010;35(24):E1406-11. Doi: 10.1097/brs.0b013e3181d952a5

Machado GC, Rogan E, Maher CG. Managing non‐serious low back pain in the emergency department: Time for a change? Emerg Med Australas. 2017;30(2):279-82. Doi: 10.1111/1742-6723.12903

Chou R, Qaseem A, Snow V, Casey D, Cross JT, Jr., Shekelle P, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478-91. Doi: 10.7326/0003-4819-147-7-200710020-00006

Cantrill SV, Brown MD, Carlisle RJ, Delaney KA, Hays DP, Nelson LS, et al. Clinical policy: critical issues in the prescribing of opioids for adult patients in the emergency department. Ann Emerg Med. 2012;60(4):499-525. doi: https://doi.org/10.1016/j.annemergmed.2012.06.013

Patel ND, Broderick DF, Burns J, Deshmukh TK, Fries IB, Harvey HB, et al. ACR Appropriateness Criteria Low Back Pain. J Am Coll Radiol. 2016;13(9):1069-78. doi: 10.1016/j.jacr.2016.06.008

Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. Lancet. 2018;391(101370):2368-83. doi: 10.1016/S0140-6736(18)30489-6n