What are the appropriate Emergency Medical Services (EMS) questions and treatment options for a 71-year-old patient presenting with back pain?

From the Guidelines

For a 71-year-old patient with back pain, EMS should first assess vital signs, level of consciousness, and pain severity using a 0-10 scale, and then provide treatment based on the severity of symptoms and the presence of red flags, as recommended by the American College of Physicians and the American Pain Society 1.

Key Assessment and Treatment Steps

• Assess vital signs, level of consciousness, and pain severity using a 0-10 scale
• Ask key questions about pain onset, location, radiation, aggravating/alleviating factors, associated symptoms, and relevant medical history
• Position the patient for comfort, often supine with knees slightly elevated
• Consider pain management options:
  • Acetaminophen (1000mg) for mild to moderate pain
  • NSAIDs like ibuprofen (400-600mg) if no contraindications exist
  • Opioids such as morphine (2-5mg IV) or fentanyl (25-50mcg IV) for severe pain
• Provide oxygen if saturation is below 94%
• Make transport decisions based on pain severity, red flag symptoms, and the patient's ability to ambulate safely
• Continuously monitor the patient during transport, especially with opioid administration, watching for respiratory depression

Important Considerations

• Be aware of red flags such as fever, bowel/bladder dysfunction, or leg weakness, which may indicate a more serious underlying condition
• Consider the patient's medical history, including cardiac conditions, and potential interactions with medications
• Balance pain relief with safety considerations, taking into account the patient's age and potential comorbidities
• Follow the guidelines and recommendations from reputable sources, such as the American College of Physicians and the American Pain Society, to ensure evidence-based care 1.

From the FDA Drug Label

NSAIDs can cause serious side effects, including: Increased risk of a heart attack or stroke that can lead to death NSAIDs should only be used: exactly as prescribed at the lowest dose possible for your treatment for the shortest time needed The patient is a 71-year-old with back pain. Ibuprofen is an NSAID that can be used to treat pain and inflammation. However, considering the patient's age and potential for bleeding, ulcers, and tears of the esophagus, stomach, and intestines, it is crucial to use ibuprofen with caution.

• The patient should take the lowest dose possible for the shortest time needed.
• The patient should be monitored for side effects, such as stomach pain, constipation, diarrhea, gas, heartburn, nausea, vomiting, and dizziness.
• The patient should seek emergency help if they experience symptoms like shortness of breath, chest pain, weakness, or slurred speech. 2

From the Research

Treatment for Back Pain in a 71-Year-Old

For a 71-year-old with back pain, the following treatment options are available:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) are often used for acute low back pain, with moderate evidence showing they are slightly more effective than placebo for short-term pain reduction 3
• Acetaminophen is also a common treatment option, although NSAIDs may be more effective for short-term pain reduction 3, 4
• Muscle relaxants and narcotic analgesics may be appropriate for some patients, but selection criteria are unclear 5, 4
• Epidural steroid injections may be beneficial for patients with radiculopathy, although the evidence is conflicting 6, 5

EMS Questions for Back Pain

When assessing a 71-year-old with back pain, EMS personnel should consider the following:

• The patient's medical history, including any previous back injuries or conditions 6
• The severity and location of the pain, as well as any radiating symptoms 6
• The patient's current medications and any potential interactions with NSAIDs or other treatments 3, 4
• The patient's ability to perform daily activities and any functional disabilities 6

Potential Risks and Side Effects

EMS personnel should also be aware of the potential risks and side effects of treatment options, including:

• NSAIDs may have more side effects than placebo, although the magnitude of the effects is small 3
• COX-2 inhibitors may have fewer side effects than traditional NSAIDs, but are associated with increased cardiovascular risks in specific patient populations 7
• Opioids and other narcotic analgesics may have significant side effects and risks, including addiction and respiratory depression 5, 4