Back Pain on Paul Nystrom

Persistent and Severe Pain

Wed, 03 Jun 2026 00:00:00 +0000

Pain is a frequent complaint that brings patients to the ER. Abdominal and chest pain are some of the most common. I often get asked by patients, usually at the end of a negative abdominal or chest pain workup, when they should come back.

This is difficult to answer. The older the patient and the more chronic medical problems they have, the higher the chance that something significant is causing their symptoms. The younger and healthier they are, the lower the chance, but diseases and disasters don’t exclude anyone 100%. Everyone knows a story of someone, often young, dropping dead with no warning. Is it likely when you are young and healthy that you can ignore most symptoms? Yes, but there are no guarantees.

Chiropractic Care

Thu, 26 Feb 2026 00:00:00 +0000

I believe that chiropractors bring something to the table that Big Medicine doesn’t. In my ER, when a patient is diagnosed with back pain, the medical record prompts me at discharge to order consults to physical therapy (PT) and chiropractic. Both are valid options.

I’ve had episodes of severe torso pain—sometimes in my ribs after a collision during ultimate frisbee, sometimes a tightness between my shoulder blades or in my lower back. Sometimes this happens with no apparent injury or trauma. I distinctly remember some severe episodes of low back pain during medical school that would happen when bending over a drinking fountain. My back would become very tense with severe pain for no apparent reason. It was very painful, but these episodes never lasted for more than a few days.

My Neurosurgeon

Sat, 10 Jan 2026 00:00:00 +0000

I was doing a ride-along with a friend of mine who works for a suburban police department. It was a call for an elderly lady with back pain. We were the closest unit and arrived before EMS did.

The patient was about 80 years old, lying in her bed fully dressed, simply waiting for the ambulance. She had a history of prior back surgeries and reported that she had “broken rods” in her back. She was scheduled to have another surgery in a couple of months. She had a back brace and her rolling walker at the bedside. She was very calm and reasonable. She did not have any pain at rest, but she said it hurt too much to move, so that’s why she wanted to go to the hospital. There was no report of any new trauma.

MRIs in the ER

Sat, 06 Sep 2025 00:00:00 +0000

There are only 2 MRIs that typically need to happen in the ER. Brains and spinal cords. There are virtually no extremity MRIs that have to happen emergently. I see patients regularly that have things that could be diagnosed on an MRI… rotator cuff tears, meniscus injuries, torn ACLs. But none of those things need emergency surgeries so they don’t need emergent MRIs. Patients often come to the ER within minutes of a knee injury and they may very well have a torn ACL. But I don’t have to find it immediately. No Ortho surgeon is rushing to the ER to fix it. You would not want them to in most cases. For things like rotator cuff tears and minor tendon or ligament tears, the first line of treatment is physical therapy and pain medicine. This is referred to as “conservative therapy”. Most of the time, this resolves the problem. Surgery is something to consider when conservative therapy fails. It is not the thing that has to happen immediately upon finding an injury.