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Mechanical Back Pain

Date Last Search Run: Feb 01, 2022
Table last updated: Oct 25, 2021
Data last added: Sep 29, 2021

Recommendation RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION   SUPPORTIVE (Green) NEUTRAL (Yellow) AGAINST (Red) NOT YET GRADED (White)
1 (strong evidence exists)    
2 (fair evidence exists)    
3 (weak evidence exists)    


Interventions

Benzodiazepines
Level Direction Primary Outcome Patient/Process Setting Reference
I Neutral (Yellow) Pain relief at 7 days Patient ED-MD Friedman BW, Irizarry E, Solorzano C, Khankel N, Zapata J, Zias E, et al. Diazepam Is No Better Than Placebo When Added to Naproxen for Acute Low Back Pain. Ann Emerg Med 2017; 70(2) 169-76.e1. Medline

Fentanyl
Level Direction Primary Outcome Patient/Process Setting Reference
III Supportive (Green) Analgesia Patient PH-Paramedic Rickard C., et al. A RCT of intranasal fentanyl vs intravenous morphine for analgesia in the prehospital setting. Am J Emerg Med 2007; 25:911-7. Medline

Ketamine
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Pain relief Patient ED-MD Miller JP., Schauer SG., Ganem VJ., Bebarta VS. Low-dose ketamine vs morphine for acute pain in the ED: A randomized controlled trial. Am J Emerg Med 2015; 33(3):402-8. Medline
III Supportive (Green) Reduction in pain Patient ED-MD Goltser A., Soleyman-Zomalan E., Kresch F., Motov S. Short (low-dose) ketamine infusion for managing acute pain in the ED: Case-report series. Am J Emerg Med 2015; 33(4):e5-7. Medline

Morphine
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Pain Scale Patient ED-MD Birnbaum A., Esses D., Bijur PE., Holden L., Gallagher EJ. Randomized double-blind placebo-controlled trial of two intravenous morphine dosages (0.10 mg/kg and 0.15 mg/kg) in emergency department patients with moderate to severe acute pain. Ann Emerg Med 2007; 49(4):445-53. Medline
I Supportive (Green) Pain relief Patient ED-MD Miller JP., Schauer SG., Ganem VJ., Bebarta VS. Low-dose ketamine vs morphine for acute pain in the ED: A randomized controlled trial. Am J Emerg Med 2015; 33(3):402-8. Medline
III Supportive (Green) Analgesia Patient PH-Paramedic Rickard C., et al. A RCT of intranasal fentanyl vs intravenous morphine for analgesia in the prehospital setting. Am J Emerg Med 2007; 25:911-7. Medline

Nitrous Oxide
Level Direction Primary Outcome Patient/Process Setting Reference
III Supportive (Green) Patient satisfaction Patient PH-Paramedic Johnson JC., Atherton Gl. Effectiveness of Nitrous Oxide in a rural EMS System. The Journal of Emergency Medicine 1991; 9:45-53. Medline

NSAIDs
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Pain Patient ED-MD Ashbrook J, Rogdakis N, Callaghan MJ, Yeowell G, Goodwin PC. The therapeutic management of back pain with and without sciatica in the emergency department: A systematic review. Physiotherapy 2020; 109:13-32. Medline


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