There are several non-pharmaceutical treatments that have also been tried to treat low back pain. For cases in which opioid medications are deemed necessary, prescribe the lowest effective dose of a short-acting opioid for the shortest time indicated.вЂќ (Level C Recommendation) вЂњPreferentially prescribe nonopioid analgesic therapies (nonpharmacologic and pharmacologic) rather than opioids as the initial treatment of acute pain in patients discharged from the emergency department. The ACEP 2020 clinical policy on the use of opioids states: However, opioids have many side effects and concerns about substance misused. We do know that opioids are very effective at reducing many types of pain including muscular skeletal pain. SGEM#304: Treating Acute Low Back Pain вЂ“ ItвЂ™s Tricky, Tricky, Tricky.SGEM#240: I CanвЂ™t Get No Satisfaction for My Chronic Non-Cancer Pain.SGEM#173: Diazepam WonвЂ™t Get Back Pain Down.SGEM#87:Let Your Back Bone Slide (Paracetamol for Low-Back Pain).There is no high-quality evidence that acetaminophen, NSAIDS, steroids, diazepam, muscle relaxants or combinations of pharmacologic modalities provide much relief. While preparing her for discharge you wonder if seeing a physiotherapist before going home from the ED would improve her outcome.Д«ackground: Acute and chronic back pain has been covered many times on the SGEM. You know mechanical low back pain is difficult to treat effectively and are trying to set expectations. She has no red flags ( TUNA FISH) and is diagnosed as having mechanical back pain without imaging as per ACEP Choosing Wisely. Her pain is eight out of ten on the zero-to-ten-point numeric pain rating scale ( NPRS). She tried acetaminophen with limited relief. Guest Skeptic:В Dagny Kane-Haas is a physiotherapist who also has a masterвЂ™s degree in Clinical Science in Manipulative Therapy.Д¬ase : A forty-year-old woman presents to the emergency department (ED) with a sore lower back after moving some boxes at home over the weekend.

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