Page 93 - PJ MED OPS Handbook 8th Ed

Back Pain

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:
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. Primary – ibuprofen 800mg PO TID (taken with food)
4. Secondary – ketorolac 15mg IM/IV q6hr. If persistent spasm after NSAID – consider midaz-
olam 2mg IM x 1.
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. Focal muscle weakness below pain level, abnormal neurologic examination
b. Bowel or bladder dysfunction
c. Saddle anesthesia

Chapter 8. Tactical Medical Emergency Protocols (TMEPs) n 91