Mechanical low back pain — MCCQE Part 1 MCQ

Correct answer: A — Provide advice to stay active, simple analgesia and safety-netting without routine imaging

Provide advice to stay active, simple analgesia and safety-netting without routine imaging is best because uncomplicated acute mechanical back pain does not need early imaging. Treat with topical therapy only despite systemic or red-flag features is suboptimal because local treatment alone is inadequate when systemic disease is possible; Delay assessment for several months is suboptimal because red-flag musculoskeletal or dermatologic presentations require timely assessment; Use antibiotics for every presentation is suboptimal because many rashes and painful joints are inflammatory, malignant or mechanical rather than bacterial; Provide opioids or reassurance as the sole management is suboptimal because symptom relief alone does not address diagnosis, function or safety. Activity is generally better than bed rest.

Reference: Choosing Wisely Canada