According to Dr. Reuben Strayer’s risk stratification tool (using reg and yellow flags), which of the following patients presenting with back pain is considered “high risk” to be harmed by opioids? I. 72 y/o M presents with back pain after a fall. His home medications include Amlodipine and Indapamide. He denies prior history of back pain. On examination he has some obvious bruising to his L side. II. 55 y/o F with back pain after a fall. She denies previous back pain or any medical history. She declines the nurse’s advanced directives for Tylenol and Ibuprofen, and requests Morphine IV as this has worked well for her before. III. 55 y/o M with chronic low back pain. He presents to ED requesting Hydromorphone. On viewing his drug formulary you note he has received 3 prescriptions for opioids in the past 2 months from different providers and different hospitals. IV. 59 y/o F with 4 hours of L sided back pain. She describes this pain as “colic” any reports that she “cannot sit still”. She denies previous back pain or medical history. She is requesting pain medication. She reports she has allergies to Tylenol and NSAIDs.

About the Author: Anton Helman

Dr. Anton Helman is an Emergency Physician at North York General in Toronto. He is an Assistant Professor at the University of Toronto, Division of Emergency Medicine and the Education Innovation Lead at the Schwartz-Reisman Emergency Medicine Instititute. He is the founder, editor-in-chief and host of Emergency Medicine Cases.