Urgent Care Management of Acute Low Back Pain: A Review of Current Evidence

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Delivery Method:	Online
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Publication Date: September 2025 (Volume 4, Number 9)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-B CME credits. CME expires 09/01/2028.

Author

Peer Reviewer

Abstract

Low back pain is a common presentation in the urgent care setting, and determining whether the cause is benign, serious, or even life-threatening can be challenging. A systematic strategy for the history and physical examination can help reduce unnecessary imaging, and an evidence-based approach will inform safe and effective pain management recommendations. This issue reviews the evidence on red-flag signs and symptoms for low back pain, current diagnostic studies recommendations, and best-practice treatment and disposition strategies.

Case Presentations

A 57-year-old woman with no significant past medical history presents to the urgent care center with left-sided low back pain radiating to the left leg...

• She arrives clutching her back and limps to the examination room.
• She said she has had low back pain before, but it is more severe today.
• On examination, you elicit pain with palpation of her left lower back and elevation of her leg. Vital signs are normal.
• You wonder whether this presentation warrants imaging and how best to treat her pain...

A 41-year-old man with a history of psoriatic arthritis presents to the urgent care with back pain and new-onset urinary incontinence...

• For 4 days, he has had difficulty controlling his urination.
• Yesterday he developed low back pain, and his legs gave out when he got out of bed.
• His vital signs are: temperature, 37.8°C; heart rate, 104 beats/min; blood pressure, 142/87 mm Hg; respiratory rate, 20 breaths/min; and oxygen saturation, normal.
• On examination, the patient is warm to touch, but he is not in distress. He has midline tenderness to palpation of his lower thoracic spine, and bilateral lower extremity weakness.
• You wonder how emergent the diagnostic testing needs to be, and how best to expedite management...

An 81-year-old man is brought into the urgent care by his daughter due to sudden-onset left-sided low back pain...

• He has a history of low back pain, but it intensified suddenly in a different location than his usual pain.
• He says he has been a lifelong cigarette smoker.
• His vital signs are normal with the exception of heart rate, 124 beats/min and blood pressure, 92/52 mm Hg.
• He appears cool, clammy, and diaphoretic, and he is in distress.
• He has no focal weakness or neurologic findings on examination.
• This seems different than a muscle strain, and you wonder what the best test would be to evaluate the cause of his back pain…

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