Present to ED primary for management of LBP, defined as pain originating between the lower border of the scapulae and the upper gluteal folds. Flank pain, that is pain originating from tissues lateral to the paraspinal muscles, will not be included.
Musculoskeletal etiology of low back. Patients with non-musculoskeletal etiologies such as urinary tract infection, ovarian cysts, or influenza like illness will be excluded. The primary clinical diagnosis, at the conclusion of the ED visit, must be a diagnosis consistent with non-traumatic, non-radicular, musculoskeletal LBP.
Patient is to be discharged home. Patients admitted to the hospital are more likely to be treated with parenteral medication and therefore are not appropriate for this study.
Age 18-64 Enrollment will be limited to adults younger than 65 years because of the increased risk of adverse medication effects in the elderly.
Non-radicular pain. Patients will be excluded if the pain radiates below the gluteal folds in a radicular pattern.
Pain duration <2 weeks (336 hours). Patients with more than two weeks of pain are at increased risk of poor pain and functional outcomes.(9)
Prior to the acute attack of LBP, back pain cannot occur more frequently than once per month. Patients with more frequent back pain are at increased risk of poor pain and functional outcomes.(9)
Non-traumatic LBP: no substantial and direct trauma to the back within the previous month
Functionally impairing back pain: A baseline score of > 5 on the Roland-Morris Disability Questionnaire

NCT03068897_inc_T1
Visit
ED
NCT03068897_inc_T2
Condition
LBP
NCT03068897_inc_T3
Observation
Present
NCT03068897_inc_T4
Condition
pain
NCT03068897_inc_T5
Qualifier
between the lower border of the scapulae and the upper gluteal folds
NCT03068897_inc_T6
Scope
Present to ED primary for management of LBP
NCT03068897_inc_T7
Scope
pain originating between the lower border of the scapulae and the upper gluteal folds
NCT03068897_inc_T8
Condition
Flank pain
NCT03068897_inc_T9
Condition
pain
NCT03068897_inc_T10
Qualifier
tissues lateral to the paraspinal muscles
NCT03068897_inc_T11
Negation
not
NCT03068897_inc_T12
Condition
urinary tract infection
NCT03068897_inc_T13
Condition
etiology
NCT03068897_inc_T14
Negation
non
NCT03068897_inc_T15
Condition
etiologies
NCT03068897_inc_T16
Qualifier
low back
NCT03068897_inc_T17
Condition
ovarian cysts
NCT03068897_inc_T18
Condition
influenza like illness
NCT03068897_inc_T19
Negation
excluded
NCT03068897_inc_T20
Scope
non-musculoskeletal etiologies
NCT03068897_inc_T21
Scope
urinary tract infection, ovarian cysts, or influenza like illness
NCT03068897_inc_T22
Condition
LBP
NCT03068897_inc_T23
Qualifier
non-radicular
NCT03068897_inc_T24
Qualifier
non-traumatic
NCT03068897_inc_T25
Qualifier
musculoskeletal
NCT03068897_inc_T26
Scope
Musculoskeletal etiology of low back
NCT03068897_inc_T27
Scope
non-traumatic, non-radicular, musculoskeletal LBP
NCT03068897_inc_T29
Person
Age
NCT03068897_inc_T30
Value
18-64
NCT03068897_inc_T31
Person
adults
NCT03068897_inc_T32
Value
younger than 65 years
NCT03068897_inc_T33
Condition
erse me ects in
NCT03068897_inc_T34
Drug
medication
NCT03068897_inc_T35
Person
elderly
NCT03068897_inc_T36
Mood
increased risk
NCT03068897_inc_T37
Negation
Non
NCT03068897_inc_T38
Qualifier
radicular
NCT03068897_inc_T39
Condition
pain
NCT03068897_inc_T40
Qualifier
musculoskeletal
NCT03068897_inc_T41
Qualifier
Musculoskeletal
NCT03068897_inc_T42
Negation
excluded
NCT03068897_inc_T43
Condition
pain
NCT03068897_inc_T44
Qualifier
below the gluteal folds in a radicular pattern
NCT03068897_inc_T45
Condition
Pain
NCT03068897_inc_T46
Temporal
duration <2 weeks
NCT03068897_inc_T47
Temporal
ion <2 w ours). Pa
NCT03068897_inc_T48
Scope
duration <2 weeks (336 hours)
NCT03068897_inc_T49
Temporal
acute
NCT03068897_inc_T50
Condition
attack of LBP
NCT03068897_inc_T52
Negation
cannot
NCT03068897_inc_T53
Condition
back pain
NCT03068897_inc_T54
Temporal
Prior to the acute attack of LBP
NCT03068897_inc_T55
Reference_point
acute attack of LBP
NCT03068897_inc_T51
Multiplier
more frequently than once per month
NCT03068897_inc_T56
Condition
LBP
NCT03068897_inc_T57
Qualifier
Non-traumatic
NCT03068897_inc_T58
Qualifier
direct
NCT03068897_inc_T59
Qualifier
substantial
NCT03068897_inc_T60
Condition
trauma
NCT03068897_inc_T61
Scope
substantial and direct
NCT03068897_inc_T62
Negation
no
NCT03068897_inc_T63
Qualifier
back
NCT03068897_inc_T64
Temporal
within the previous month
NCT03068897_inc_T65
Scope
no substantial and direct trauma to the back within the previous month
NCT03068897_inc_T66
Scope
Non-traumatic LBP
NCT03068897_inc_T67
Qualifier
Functionally impairing
NCT03068897_inc_T68
Condition
back pain
NCT03068897_inc_T69
Measurement
Roland-Morris Disability Questionnaire
NCT03068897_inc_T70
Temporal
baseline
NCT03068897_inc_T71
Value
score of > 5
NCT03068897_inc_T72
Scope
Functionally impairing back pain
NCT03068897_inc_T73
Scope
baseline score of > 5 on the Roland-Morris Disability Questionnaire