key: cord-1025144-7bq0nhwm
authors: Borsa, Stefano; Pluderi, Mauro; Carrabba, Giorgio; Ampollini, Antonella; Pirovano, Marta; Lombardi, Francesco; Tomei, Massimo; Locatelli, Marco
title: Impact of COVID-19 outbreak on acute low back pain
date: 2020-05-29
journal: World Neurosurg
DOI: 10.1016/j.wneu.2020.05.218
sha: 132d7c35459f7c643513d203d093d31c2a772d59
doc_id: 1025144
cord_uid: 7bq0nhwm

nan

We would like to bring our contribution from one of the most affected regions of the world by the SARS-CoV-2 on how pandemic has influenced the number of visits for low back pain and to provide food for thought for a reorganization of low back pain management in the post-COVID-19 era. Since Feb 20th, 2020, when the first person-to-person transmission of the SARS-CoV-2 was reported in Italy, the COVID-19 outbreak has reached the pandemic status. The Italian health system had to reorganize entire hospitals to care an unprecedented number of patients who needed urgent treatments at the same time; since March 8 th , 2020 hubs were identified for specific urgent or tumoral pathologies [2] . What about patients who have no acute respiratory syndrome or no life-threatening or tumoral conditions? What about patients with pathologies that are usually referred to the emergency ward as acute low-back pain? Low-back pain has an incidence of around 5% a year and up to 90% of the population experiences the pathology at least once in their lives; it accounts for around 3% of emergency ward visits in the US [3] . Although the vast majority (85 -90 %) of patients with acute low-back pain have symptomatology that tends to regress within 4 -6 weeks [4] , there is a minority where the cause of the pain is a serious pathology: the prevalence of cancer is around 1% and that of vertebral fracture around 4% [5] . The importance of psychological status on the pain perception and complain is clear but few reports have studied the impact of emergency settings (i.e. natural disasters, wars, pandemics) on pain management [6] . We collected data from 4 hospitals in Milan on Emergency Ward (EW) and on Outpatient Department (OD) visits for acute low back pain (ALBP) for the period March 8 th , 2020 -April 8 th , 2020 and for the same period of the previous year. Last month 103 patients came for ALBP, 73 in the EWs and 30 in the ODs. In the EWs 45 patients had LBP, 22 presented sciatica, 5 had fractures (porotics) and 1 a tumor (prostate cancer). In the ODs 12 patients presented LBP, 15 presented sciatica, 2 had fractures (porotics) and 1 a tumor (breast cancer). The patients presented during the same period in 2019 were 802, 647 in the EWs and 155 in the ODs. In the EWs 352 patients had LBP, 245 presented sciatica, 47 had fractures (8 traumatics and 39 porotics) and 3 tumors (2 breast cancers, 1 prostate cancer). In the ODs 52 patients had LBP, 89 presented sciatica, 8 had fractures (porotics) and 6 tumors (2 breast cancers, 3 prostate cancers and 1 colorectal cancer). The data we collected showed a clear reduction (-87.2 %) of patients presenting for ALBP. The decrease of visits might reflect the reduction of traumatic cases due to the lock-down that is limiting the movement of people but in most cases this is probably related to the fear of being exposed to SARS-CoV-2 in a nosocomial environment. Despite the scarcity of available resources due to pandemic, the vast majority of patients with ALBP would have had the opportunity to access hospitals, but they decided not to. In a normal situation how many patients that we see in EW or OD for ALBP really need an urgent nosocomial evaluation? The Covid-19 outbreak is changing our every-day life but we could exploit this exceptional moment for a reorganization of our emergency system; we'll have to strengthen the local medicine by training and by providing guidelines and diagnostic pathways for general practitioners so to identify the cases (tumors, unstable fractures or patients with neurological deficits) who need evaluation in a hospital setting [5] ; furthermore, we will have to deal with COVID-19 for the months to come and it will be imperative to implement tools, such as telemedicine, that allow adequate evaluations and treatments while maintaining the necessary social distancing [7] .

The response of Milan's Emergency Medical System to the COVID-19 outbreak in Italy

Evaluation and Treatment of Acute Back Pain in the Emergency Department

United States Agency for Health Care Policy and Research. Acute low back pain problems in adults. Clinical practice guidelines

Red flags presented in current low back pain guidelines: a review

Pain and Natural Disaster

Virtually Perfect? Telemedicine for Covid-19

No funding was provided for any author on this article, and there are no known conflicts of interest for any author. Author contributions: the authors would like to thank Cojazzi V. and Egidi M. for their contribution. 

Declaration of interests X The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.☐The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: