Mount Carmel Health Partners Clinical Guidelines Low Back Pain | Page 2

Quick Guide to Low Back Pain Treatment
 Initial exam: rule out red flag indicators and high-risk patients
 Document presence or absence of red flag indicators
If red flag indicators are absent:
• Begin conservative treatment approach
- Encourage activity and heat
- Encourage non-pharmacalogical approach
- Patient education and expectations of testing and treatment
• Acetaminophen (caution if liver disease)
• NSAIDs/Ibuprofen (caution if Diabetes, renal disease, ulcer disease/ GERD, antiplatelet, or anticoagulant therapy
Presence of Red Flag Indicators
Neoplasm/Serious
Disease
Suspected or
Present
Infection
(epidural abscess,
discitis)
CBC/ESR/UA/Blood C/S
MRI with contrast for infection
and without contrast for
neoplasm or CT myelogram; if
suspicion persists,
consider consultation/bone
scan, or additional cancer
screening labs; consult
appropriate specialist as
needed
Trauma or Spinal
Fracture suspected
(anterior wedge,
posterior element,
burst fracture)
Severe Neurologic
Deficits (cauda
equina or cord
compression)
Plain film—immediately or if after 10 days
symptoms persist; consider CT without
contrast or bone scan and consultation if
concern for more than compression fracture;
if posterior vertebral body fracture (burst
fracture), then consider MRI without contrast
to assess if acute or chronic and non-osseous
sequela of trauma i.e., hematoma, ligament
injury, cord involvement; consult appropriate
specialist as needed
MRI without contrast
(or CT myelogram if
MRI not possible);
prompt surgical
consultation if patient
has signs of cord
compression or cauda
equine syndrome;
consult appropriate
specialist as needed
Risk factors for cancer related to back pain imaging:
• Age ˃50 or history of cancer
• Failure of improved symptoms after 4-6 weeks of conservative back pain therapy
• Unexplained weight loss
**If unsure that patient is an appropriate candidate for MRI, call radiographers for assistance
and guidance: Mount Carmel East MRI Department, 614-234-7585.
Low Back Pain - 2
Vascular Origin
Suspected (AAA or
retroperitoneal
hematoma) Post-op Pain;
consider infection,
vascular, urologic
or other source
Bedside US or CT
with contrast;
prompt surgical
consultation;
Consult
appropriate
specialist as
needed US, MRI with
contrast; consult
appropriate
specialist as
needed