A Pain in the Back COPYRIGHT © 2013, ALL RIGHTS RESERVED From the Publishers of.

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Presentation transcript:

A Pain in the Back COPYRIGHT © 2013, ALL RIGHTS RESERVED From the Publishers of

Copyright © 2013 Terms of Use The Consult Guys ® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the Consult Guys ® slide sets constitutes copyright infringement.

Copyright © 2013 Dear Consult Guys; I need your advice in my care of a patient with back pain. I saw Mr. G earlier today for back pain. I last saw him 3 weeks ago for treatment of a “boil” located on his back. He had a low grade fever but otherwise seemed well. I advised him to do warm soaks and according to him the boil resolved…. Dear Consult Guys; I need your advice in my care of a patient with back pain. I saw Mr. G earlier today for back pain. I last saw him 3 weeks ago for treatment of a “boil” located on his back. He had a low grade fever but otherwise seemed well. I advised him to do warm soaks and according to him the boil resolved….

Copyright © 2013 He returned today with 3 days of back pain. He’s had no incontinence or lower extremity weakness. There was mild tenderness to palpation but his exam otherwise normal. He is a diabetic and his diabetes is well controlled. I’ve tried to be selective in ordering imaging tests so in this case rather than ordering an imaging test I initiated anti- inflammatory medical therapy and suggested that he see me in follow-up in 4 weeks. In thinking more about the case I am just not sure that not ordering an imaging study was correct. What would you guys have done? He returned today with 3 days of back pain. He’s had no incontinence or lower extremity weakness. There was mild tenderness to palpation but his exam otherwise normal. He is a diabetic and his diabetes is well controlled. I’ve tried to be selective in ordering imaging tests so in this case rather than ordering an imaging test I initiated anti- inflammatory medical therapy and suggested that he see me in follow-up in 4 weeks. In thinking more about the case I am just not sure that not ordering an imaging study was correct. What would you guys have done?

Copyright © 2013 ACP Guideline Published in

Copyright © 2013 Back pain is very common A selective approach to back pain imaging is recommended Key Points

Copyright © 2013 Indications for immediate imaging Major risk factors for cancer as a cause Risk factors for spinal infection Evidence of cauda equina syndrome  Urinary retention  Fecal incontinence  Saddle anesthesia

Copyright © 2013 Mr. G Diabetic Boil 3 weeks ago Malaise Tenderness L3-L4

Copyright © 2013 Epidural abscess Identifiable portal of entry in 2/3  Spinal surgery  Epidural catheter  Skin – soft tissue infection  Hematogenous (iv drug use) Classic: fever + spine tenderness + neurologic  Most not classic MRI

Copyright © 2013 Consult Guys Replies Mr. G’s presentation suggests epidural abscess An MRI should be done

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