Evaluation and Management of Neck and Back Pain

John W. Martel, MD, PhD, FACEP; Samuel B. Potter, MD


Semin Neurol. 2019;39(1):41-52. 

In This Article

Abstract and Introduction


Neck and back pain are common reasons for seeking evaluation and treatment in the emergency department. Within both systems there exist several time-sensitive diagnoses that the emergency provider should be familiar with in order to prevent significant morbidity and mortality. In this article we provide a general overview of these complaints by discussing problems in a systems-based fashion as well as discussing the initial evaluation, work-up, and treatment options for these diagnoses.


Back pain is a common reason for seeking medical evaluation in the United States and is one of the top five most common emergency department (ED) chief complaints.[1,2] Nearly 90% of patients who present with atraumatic back pain ultimately have no clear etiology for their discomfort and experience varying degrees of pain relief within 4 to 6 weeks irrespective of therapy.[3–6] However, approximately 2% of acute back pain complaints are attributed to life- and/or function-threatening processes.[7] The role of the physician is to identify those with emergent etiologies that require urgent interventions from those with benign causes. The provider should also be aware of the evidence and recommendations surrounding the treatment options for nontraumatic low back pain.

Neck pain is also a common chief complaint in U.S. adults, but occurs less frequently than lower back pain and is not associated with the same degree of physical disability, decreased productivity/income loss, and health care expenditure as that attributed to back pain[8–10] There are several high-risk diagnoses in each system that must be considered when distinguishing between patients who can be safely discharged from the ED with conservative treatment and those who require more comprehensive diagnostic evaluation.