Page 192 - ATP-P 11th Ed

BACK PAIN PROTOCOL

SPECIAL CONSIDERATIONS
Motor weakness, saddle anesthesia, sensory loss, loss of bowel or bladder control
in the setting of back pain is a neurological emergency requiring Urgent evacuation.
Signs and Symptoms
SECTION 2 1. Pain may worsen with movement.
2. Pain may radiate into legs.
Management
1. Treat per Pain Management Protocol.
2. Apply cold compress to painful area for 20–25 minutes tid.
3. Trigger point injections with local anesthetic (IF TRAINED). Lidocaine 1–2mL
per trigger point. May repeat daily for 2 days.
4. Consider diazepam (Valium ) 5–10mg IM/IV/PO. Repeat once in 6–8hr prn.
®
5. Minimize activity initially, but encourage gradual stretching and return to full mobility
as soon as tolerated.
6. If back pain is accompanied by fever and/or urinary symptoms, treat per Flank Pain
Protocol.

Disposition
1. Evacuation is often not required if the back pain responds to therapy.
2. Routine evacuation for severe cases not responding to therapy.
3. Urgent evacuation for patients with neurological involvement (other than pain)
such as:
a. Weakness
b. Bowel or bladder dysfunction
c. Saddle anesthesia

182 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 183