The first step many people take when experiencing acute low back pain is a visit to the emergency room. In one study, less than 1% of ER visits related to back pain resulted in treatment for specific pathology in the back (infection, fracture, tumour etc). Most patients are sent home from the ER with no treatment, testing or imaging at all. This is not a problem with ER physicians, but rather a problem with an emergency room system that is ill equipped to manage acute back pain and effective education of the public about diagnostic and treatment options available that are more suitable for addressing low back pain. We live in a country that provides healthcare for all, but the system cannot handle the frequent ER visits related to low back pain. We cannot change our healthcare system overnight but we can educate and change our behaviours to make evidence based choices of where to seek appropriate care.
First line therapy should be non-pharmaceutical. National guidelines endorse the use of exercise, massage, acupuncture and spinal manipulation in the management of acute (new onset or sudden episode) low back pain. It is not necessary to get images (x-ray, CT, MRI), prescriptions or referrals for these services from your physician prior to seeing a physiotherapist, chiropractor or massage therapist. If you feel like you need to medicate, do not use opioids, instead guidelines recommend a non-steroidal anti-inflammatory (NSAID), with the minimal effective dose for the shortest amount of time.