Book contents
- Emergency Department Analgesia
- Emergency Department Analgesia
- Copyright page
- Contents
- Contributors
- Foreword
- Preface
- Acknowledgments
- Abbreviations
- General considerations
- Chief complaints and diagnoses
- Abdominal aortic aneurysm
- Aortic dissection
- Arthritis
- Biliary tract pain
- Bites and stings – marine
- Bites and stings – terrestrial
- Breast pain
- Burns
- Bursitis and periarticular inflammation
- Cancer and tumor pain
- Cardiac chest pain
- Chest wall trauma
- Chronic low-back pain
- Cluster headache
- Corneal abrasion
- Cystitis, urethritis, and prostatitis
- Dysmenorrhea
- Endometriosis
- Esophageal spasm
- Fibromyalgia
- Gastritis and peptic ulcer disease
- Gastroesophageal reflux disease
- Hemorrhoids and perianal pain
- Migraine and undifferentiated headache
- Mucositis and stomatitis
- Neck and back pain – mechanical strain
- Neck and back pain – radicular syndromes
- Neck and back pain – spinal spondylitic syndromes
- Neuropathy – complex regional pain syndrome
- Neuropathy – diabetic
- Neuropathy – HIV related
- Neuropathy – overview
- Neuropathy – phantom limb pain
- Ocular inflammation
- Odontalgia
- Orthopedic extremity trauma – sprains, strains, and fractures
- Osteoporotic vertebral compression fracture
- Otitis media and externa
- Pancreatitis
- Pharyngitis
- Postdural puncture headache
- Post-herpetic neuralgia
- Renal colic
- Sialolithiasis
- Sickle cell crisis
- Temporomandibular disorders
- Tension-type headache
- Trigeminal neuralgia
- Undifferentiated abdominal pain
- Tables
Chronic low-back pain
from Chief complaints and diagnoses
Published online by Cambridge University Press: 18 December 2009
By
Edited by
Book contents
- Emergency Department Analgesia
- Emergency Department Analgesia
- Copyright page
- Contents
- Contributors
- Foreword
- Preface
- Acknowledgments
- Abbreviations
- General considerations
- Chief complaints and diagnoses
- Abdominal aortic aneurysm
- Aortic dissection
- Arthritis
- Biliary tract pain
- Bites and stings – marine
- Bites and stings – terrestrial
- Breast pain
- Burns
- Bursitis and periarticular inflammation
- Cancer and tumor pain
- Cardiac chest pain
- Chest wall trauma
- Chronic low-back pain
- Cluster headache
- Corneal abrasion
- Cystitis, urethritis, and prostatitis
- Dysmenorrhea
- Endometriosis
- Esophageal spasm
- Fibromyalgia
- Gastritis and peptic ulcer disease
- Gastroesophageal reflux disease
- Hemorrhoids and perianal pain
- Migraine and undifferentiated headache
- Mucositis and stomatitis
- Neck and back pain – mechanical strain
- Neck and back pain – radicular syndromes
- Neck and back pain – spinal spondylitic syndromes
- Neuropathy – complex regional pain syndrome
- Neuropathy – diabetic
- Neuropathy – HIV related
- Neuropathy – overview
- Neuropathy – phantom limb pain
- Ocular inflammation
- Odontalgia
- Orthopedic extremity trauma – sprains, strains, and fractures
- Osteoporotic vertebral compression fracture
- Otitis media and externa
- Pancreatitis
- Pharyngitis
- Postdural puncture headache
- Post-herpetic neuralgia
- Renal colic
- Sialolithiasis
- Sickle cell crisis
- Temporomandibular disorders
- Tension-type headache
- Trigeminal neuralgia
- Undifferentiated abdominal pain
- Tables
Summary
This chapter focuses on pharmacological approaches to chronic low-back pain (CLBP). In CLBP, one of the major issues for the ED caregiver is use of opioids. The utility of opioids in CLBP is limited not only by their marginal analgesic efficacy, but also by the risk of addictive behavior. Although studies of truly CLBP are lacking, it is reasonable to use NSAIDs provided that potential side effects risks are incorporated into therapeutic decision-making. Some authors recommend avoiding the potential cardiovascular risk with COX-2 selective NSAIDs by instead prescribing dual therapy with a non-selective NSAID and a proton pump inhibitor. A 2003 meta-analysis found five RCTs demonstrating some CLBP relief with cyclic anti-depressants. The benefits of these cyclic anti-depressants are independent of their anti-depressant effects, since studies demonstrating the agents' efficacy excluded patients with clinical depression.
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- Emergency Department AnalgesiaAn Evidence-Based Guide, pp. 175 - 179Publisher: Cambridge University PressPrint publication year: 2008