
 | RISK MANAGEMENT AND PATIENT SATISFACTION Audio-Digest Emergency Medicine Volume 24, Issue 24 December 21, 2007 Risk, errors, and patient satisfaction Kevin M. Klauer, DO What is the best evidence for the management of acute back pain? Ann P. Nguyen, MD


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 Points of Care Strategies for .. satisfaction: .. never tell patient no need to return to ED; .. patient much less likely to sue .. if patient thinks physician did his or her best; .. patients would rather have ED physician refer them to specialist (than own FP).. encourage patient to ask questions; effective pain management important; .. let patient speak for at least 1 min; explain your impression (not final diagnosis) to patient; .. family members should agree with plan; .. NSAIDs: most commonly prescribed drugs for low back pain; plethora of literature .. statistically significant improved relative risk for decrease in pain, and that NSAIDs did not produce greater adverse effects than placebo; Opioids: 3 studies of opioids .. better than placebo in relieving back pain and improving function .. Steroids: paucity of data .. only one that used intramuscular (IM) steroids for low back pain in ED; only handful of studies on low back pain in ED; Physical interventions: .. back exercises not helpful in relieving acute low back pain but marginally helpful in chronic low back pain; bed rest detrimental to recovery; good evidence that heat better than other interventions, but no data about cold compared to other interventions.
Dr. Klauer at 18th Annual High-Risk Emergency Medicine, Apr 16-17, 2007, in Las Vegas, NV, by the Center for Emergency Medicine Education. Dr. Nguyen at Contemporary Concepts in Clinical Emergency Medicine, June 6-8, 2007, in NY, NY, by the New York Univ Sch of Med, Dept of Em Med.

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