Paramedic management of back pain: a scoping review

Abstract

Background Research examining paramedic care of back pain is limited. Objective To describe ambulance service use and usual paramedic care for back pain, the effectiveness and safety of paramedic care of back pain, and the characteristics of people with back pain who seek care from paramedics. Methods We included published peer-reviewed studies of people with back pain who received any type of paramedic care on-scene and/or during transport to hospital. We searched MEDLINE, EMBASE, CINAHL, Web of Science and SciELO from inception to July 2022. Two authors independently screened and selected the studies, performed data extraction, and assessed the methodological quality using the PEDro, AMSTAR 2 and Hawker tools. This review followed the JBI methodological guidance for scoping reviews and PRISMA extension for scoping reviews. Results From 1987 articles we included 26 articles (25 unique studies) consisting of 22 observational studies, three randomised controlled trials and one review. Back pain is frequently in the top 3 reasons for calls to an ambulance service with more than two thirds of cases receiving ambulance dispatch. It takes ~ 8 min from time of call to an ambulance being dispatched and 16% of calls for back pain receive transport to hospital. Pharmacological management of back pain includes benzodiazepines, NSAIDs, opioids, nitrous oxide, and paracetamol. Non-pharmacological care is poorly reported and includes referral to alternate health service, counselling and behavioural interventions and self-care advice. Only three trials have evaluated effectiveness of paramedic treatments (TENS, active warming, and administration of opioids) and no studies provided safety or costing data. Conclusion Paramedics are frequently responding to people with back pain. Use of pain medicines is common but varies according to the type of back pain and setting, while non-pharmacological care is poorly reported. There is a lack of research evaluating the effectiveness and safety of paramedic care for back pain.

Emergency presentations for older persons with low back pain: An increasing clinical and economic challenge

“…Of note however is that the same review reported that up to one third of these ED transfers were avoidable. 27 Our findings of increasing LBP ED presentations and greater serious pathology in the older age group highlight the need for further research into changing ambulance usage and the resultant hospital sequelae of ambulance transfers for LBP to the ED.…”

BUSER Transcutaneous Electric Nerve Stimulator Device Design

“…Transcutaneous electrical nerve stimulation (TENS) is a physical therapy method commonly used in the treatment of pain (Vance et al, 2012;Santuzzi et al, 2013). It is used as a technique with successful results in the reduction of fibromyalgia (Dailey et al, 2022), primary dysmenorrhea pain (Arik et al, 2022), shoulder pain (Bilek et al, 2021), back pain (Vella et al, 2022) and chronic cancer pain (Katta et al, 2022). TENS enhances local inhibitory control and is indicated in focal neuropathic pain (NP) (Guastella et al, 2008).…”