Page 296 Acute Pain Management
P. 296
The following tick boxes represent conclusions based on clinical experience and expert
opinion.
Acute pain following burn injury can be nociceptive and/or neuropathic in nature and may
be constant (background pain), intermittent or procedure‐related.
Acute pain following burn injury requires aggressive multimodal and multidisciplinary
treatment.
9.4 ACUTE BACK PAIN
Acute back pain in the cervical, thoracic, or, in particular, lumbar and sacral regions, is a
common problem affecting most adults at some stage of their lives. The causes are rarely
serious, most often non‐specific and the pain is usually self‐limiting.
Appropriate investigations are indicated in patients who have signs or symptoms that might
indicate the presence of a more serious condition (‘red flags’). Such ‘red flags’ include
symptoms and signs of infection (eg fever), risk factors for infection (eg underlying disease
process, immunosuppression, penetrating wound, drug abuse by injection), history of trauma
or minor trauma, history of osteoporosis and taking corticosteroids, past history of
malignancy, age greater than 50 years, failure to improve with treatment, unexplained weight
loss, pain at multiple sites or at rest and absence of aggravating features (Australian Acute
Musculoskeletal Pain Guidelines Group, 2003). A full neurological examination is warranted in the
presence of lower limb pain and other neurological symptoms (eg weakness, foot drop, cauda
equina syndrome, loss of bladder and/or bowel control).
Psychosocial and occupational factors (‘yellow flags’) appear to be associated with an
increased risk of progression from acute to chronic pain; such factors should be assessed early
in order to facilitate appropriate interventions (Australian Acute Musculoskeletal Pain Guidelines
Group, 2003).
NHMRC guidelines for the evidence‐based management of acute musculoskeletal pain include
chapters on acute neck, thoracic spinal and low back pain (Australian Acute Musculoskeletal Pain
CHAPTER 9 Guidelines Group, 2003). In view of the high quality and extensiveness of these guidelines, no
further assessment of these topics has been undertaken for this document. The following key
messages are an abbreviated summary of key messages from these guidelines; the practice
points recommended for musculoskeletal pain in general are listed in Section 9.5 and
represent the consensus of the Steering Committee of these guidelines. These guidelines can
be found on the NHMRC website (Australian Acute Musculoskeletal Pain Guidelines Group, 2003).
Since their publication, a number of further guidelines have been published that are worth
considering. These include:
• The Health Care Guideline: Adult Low Back Pain of the Institute for Clinical Systems
Improvement (ICSI, 2008).
• The Guideline on Management of Acute Low Back pain by the Michigan Quality
Improvement Consortium (Michigan Quality Improvement Consortium, 2008).
• Clinical Guidelines for Best Practice Management of Acute and Chronic Whiplash‐
Associated Disorders (South Australian Centre for Trauma and Injury Recovery and
endorsed by NHMRC) (TRACsa, 2008).
• American Pain Society and American College of Physicians clinical practice guidelines. These
cover both acute and chronic low back pain (Chou & Huffman, 2007a; Chou & Huffman 2007b;
Chou et al 2007).
248 Acute Pain Management: Scientific Evidence
