No abstract

ow back pain is the most common musculoskeletal symptom among people visiting emergency departments, and it is one of the top five most frequent complaints in emergency medicine. 1 A systematic review of 21 studies undertaken during 2000-2016 in 12 countries found that low back pain was consistently among the most frequent complaints in emergency medicine. 2 Despite numerous studies and recommendations, a recent systematic review found that the utility of standard pharmacological treatments for acute back pain is limited. 3 Accepted class II evidence indicates that patient education, superficial heat, paracetamol, non-steroidal antiinflammatory drugs, and the limited use of skeletal muscle relaxants and opioids can be beneficial. 1 It is reported that emergency physicians often choose opioid therapy, including 61% in a large American national sample 4 and 70% in an Australian study. 5 However, medical therapy for low back pain is of modest benefit. Cannabidiol (CBD) is the major non-psychotropic phytocannabinoid in Cannabis sativa (up to 40% of extracted alkaloids). 6 Unlike most cannabinoids, including tetrahydrocannabinol (THC), CBD does not have psychomotor or cognitive effects, and its safety profile is good. 6 CBD has attracted increasing medical interest because of its anxiolytic, anti-inflammatory, anti-emetic, anti-epileptic, and anti-psychotic effects. [6][7][8][9] It has been approved in several countries for the treatment of neuropathic pain. 10 The most frequently reported side effects of acute ingestion of CBD are dizziness or drowsiness, itching or rash, headache, abdominal discomfort, nausea, and vomiting or diarrhoea. 9,11 Although CBD and its analogues may be beneficial for reducing pain caused by inflammation, its utility for treating acute low back pain has not been assessed. 11 The objective of our study was to compare the analgesic effect and safety of single oral administration of CBD as an adjunct to standard care for patients who presented to an emergency department with acute, non-traumatic low back pain, with those of a placebo. MethodsThe CANBACK trial was a single centre, randomised, double blinded, placebo-controlled clinical trial. Adults with acute, nontraumatic low back pain who presented to the Austin Hospital emergency department (Melbourne) during 21 May 2018 -13 June 2019 were recruited. The Austin Hospital tertiary emergency department treats 90 000 patients each year, and offers a wide range of clinical services. The trial was registered with the Australian New Zealand Clinical Trials Registry on 4 April 2018 (ACTRN12618000487213). ParticipantsPatients with acute low back pain were identified by the study investigators and clinical staff (medical and nursing) working in the triage and fast track areas of the emergency department, and were managed in the short stay unit. Participants were provided

Commonly performed laboratory tests identify surgical ward patients at risk of early major adverse events. Further studies are needed to assess whether such identification system can be used to trigger interventions that help improve patient outcomes.