Last updated on January 27th, 2024 at 09:27 am
Back Pain Nursing Care Plans Diagnosis and Interventions
Back Pain NCLEX Review and Nursing Care Plans
Back pain is a health condition that can be caused by injury, physical exercise, and various medical problems.
People of any age may experience back pain for a variety of reasons. Because of family history, previous occupations, and/or degenerative disk disease, lower back pain is more likely to develop as people age.
The bony lumbar spine, the discs between the vertebrae, the ligaments surrounding the spine and discs, the spinal cord and nerves, the lower back muscles, the abdominal and pelvic internal organs, and the skin around the lumbar region may all be contributing factors to lower back pain.
Signs and Symptoms of Back Pain
- dull pain in any part of the back
- sharp, stabbing pain that may travel from the leg to the foot
- inability to stand up straight without any pain
- restricted back’s range of motion and its capacity to flex
- inflammation on the back
- difficulty urinating
- acute pain that begins quickly and can last for up to 6 weeks
- chronic pain or long-term pain that lasts more than three months because it progresses more slowly
- numbness around the buttocks
- persistent back pain even when lying down
- numbness in the legs
- fever
- weakness
- inability to walk
- severe back pain that is persistent and do not improve with medications.
Causes of Back Pain
- Muscle or ligament strain. Back muscles and spinal ligaments might get strained as a result of frequent heavy lifting or a sudden uncomfortable movement. Constant tension on the back can result in excruciating muscle spasms if in poor physical shape.
- Structural problems. Back pain can be brought on by a variety of structural issues, such as:
- Ruptured or bulging disk. The spine’s vertebrae, or bones, are padded by disks. A disk’s soft interior can swell or burst, pressing on a nerve. A ruptured or bulging disk, however, might exist without causing back discomfort.
- Arthritis. Lower back pain is a side effect of osteoarthritis. Spinal stenosis, also known as a narrowing of the area around the spinal cord, is a disorder that can occasionally result from arthritis in the spine.
- Sciatica. A bulging or herniated disk pressing on a nerve causes acute, shooting pain to go through the buttock and down the back of the leg.
- Kidney problems. Back discomfort can result from kidney issues such as kidney infections or stones.
- Osteoporosis. Compression fractures are more common due to the brittleness and porousness of bones, including the spine’s vertebrae.
- Ankylosing spondylitis. a specific type of arthritis of the spine.
- Posture and movement. Adopting a very slumped posture can eventually worsen back and shoulder issues.
- Medical disorders. Certain medical conditions can also cause back pain.
- Spinal cancer. Back discomfort may be caused by a tumor on the spine pressing against a nerve.
- Spinal infection. A fever and a sore, warm spot on the back may be symptoms of a spinal infection.
Risk Factors to Back Pain
- Age. Beginning about age 30 or 40, back discomfort becomes more prevalent.
- Lack of exercise. Back pain may be caused by underutilized, weak abdominal and back muscles.
- Extra weight. Excess weight puts extra pressure on the back.
- Diseases. Back pain can be exacerbated by certain cancers and forms of arthritis.
- Incorrect lifting. Back pain might result from using the back instead of the legs when lifting.
- Psychological disorders. Back pain seems to be more common among people who are prone to depression and anxiety.
- Smoking. Back pain among smokers is more common. This might happen because smoking causes coughing and coughing can cause herniated discs. Smoking also raises the risk of osteoporosis and reduces blood flow to the spine.
- Gender. Back pain appears to affect more women than males, probably because of hormonal differences.
- Occupational activities. Sitting is one of the most frequently mentioned risk factors for back pain that is work-related. Other risk factors may include strenuous physical activity, heavy lifting, pushing and pulling postures, and exposure to whole-body vibration (WBV), such as motor vehicle driving.
- Pregnancy. The body’s ligaments naturally soften and stretch as giving birth is getting closer. Back pain may result from the tension in the joints in the lower back and pelvis.
- Sedentary lifestyle. Inactivity for an extended period of time makes back pain worse because the back becomes tight, weak, and deconditioned.
- Genetic factors. There is strong evidence that low back pain or degenerative disk disorders may be inherited, according to recent genetic studies.
Complications of Back Pain
- Poor sleep. Untreated back pain makes it difficult to find a comfortable, supported position for the duration of the night, which can make it difficult to have a restful night’s sleep.
- Loss of mobility. Losing the freedom of movement can lead to a loss of independence, which is another factor that can cause or exacerbate depression. Muscle deterioration and weight gain are other adverse effects of being immobile, both of which can cause more serious health issues.
- Muscle fatigue. The body depends on the muscles, bones, and ligaments in the back to be able to move freely. The remainder of the body will be constrained if that body part isn’t functioning at its best. If there is a persistent back pain, muscle fatigue can be easily felt.
- Chronic back pain. Acute back pain can develop into chronic back pain, which is discomfort that lasts for 12 weeks or longer, if the injury is not healed properly. Chronic back pain has been linked to drug use, anxiety, depression, and a lower quality of life.
- Spine injury. Back pain, especially in the spine, frequently causes new or worsening pain in other areas of the back. A back pain that is neglected for an extended period of time causes nerve irritation, which can cause lasting impairments such as spinal stenosis , radiculopathy, and nerve loss.
- Depression. Chronic pain can be the cause of most prevalent mood disorders, including depression, people with chronic back pain are more likely to experience financial difficulties as a result of missed work and medical expenses.
Diagnosis of Back Pain
- Physical assessment. The back will be checked, and the ability to sit, stand, walk, and lift the legs will be evaluated by the doctor. Along with asking the rate of pain on a scale of zero to 10.
- X-ray. This can indicate damage to the muscles, spinal cord, nerves, or disks, as well as the alignment of the bones and indications of arthritis or broken bones.
- MRI or CT scan. Thiscan determine herniated disks or issues with tissue, tendons, nerves, ligaments, blood vessels, muscles, and bones.
- Bone scans. These can find osteoporosis-related compression fractures or bone cancers. Injection of a radioactive agent or tracer into a vein. Using a dedicated camera, the tracer accumulates in the bones and aids the doctor in identifying bone issues.
- Electromyography, or EMG. This can measure the electrical impulses generated by nerves in reaction to muscular contractions. This can demonstrate the presence of nerve compression, which can be brought on by a herniated disk or spinal stenosis.
- Blood tests and urine tests. This can determine the presence of infection and any other underlying conditions.
- Osteopathy. Using touch and visual examination, an osteopath makes a diagnosis related to back pain via pressure or indirect approaches, slow and rhythmic stretching known as mobilization, and manipulation of joints and muscles.
Treatment for Back Pain
- Medications. The doctor may advise one of the following medications, depending on the type of back pain:
- OTC (over-the-counter) analgesics. Back pain may be alleviated by nonsteroidal anti-inflammatory medicines (NSAIDs). However, serious side effects might result with overuse.
- Muscles relaxants. The doctor might also recommend a muscle relaxant if mild to moderate back pain doesn’t go away after trying over-the-counter pain medicines.
- Topical analgesics. These provide analgesics through the skin in the form of creams, salves, ointments, or patches.
- Narcotics. Under the watchful supervision of the doctor, opioid-containing medications may be used for a brief period of time because opioids don’t effectively treat persistent pain.
- Antidepressants. There is evidence that some antidepressants can treat chronic back pain without affecting depression.
- Physical therapy. Exercises help to strengthen the back and abdominal muscles, boost flexibility, and correct the posture. Regular application of these methods can aid in preventing pain from reappearing.
- Surgical and other procedures. Surgical intervention for persistent severe back pain may include:
- Cortisone injection. The area surrounding the spinal cord may be injected with cortisone, a potent anti-inflammatory drug, along with a numbing agent if other treatments are unsuccessful and the discomfort travels down the leg (epidural space).
- Radiofrequency neurotomy. During this process, a little needle is placed into the skin with its tip close to the painful spot. The passage of pain signals to the brain is hampered by the needle-damaging radio waves that are sent through it.
- Nerve stimulator implants. Certain nerves can receive electrical impulses from implanted devices to inhibit pain signals.
- Surgery. Surgery may be beneficial if the patient is experiencing persistent pain accompanied by radiating leg pain or growing muscular weakening brought on by nerve compression. These procedures are often only used when other treatments have failed to relieve pain caused by structural issues, such as a herniated disk or narrowing of the spine.
Nursing Diagnosis for Back Pain
Back Pain Nursing Care Plan 1
Nursing Diagnosis: Chronic Pain related to spinal bone changes secondary to osteoporosis as evidenced by back pain, inability to walk or stand normally, muscle stiffness and stooped posture.
Desired Outcomes:
- The patient will rate pain at a level less than 3 to 4 on a 0 to 10 rating.
- The patient will be able to utilize pharmacological and nonpharmacological pain relief methods.
- The patient will achieve or maintain desired functional mobility.
| Nursing Intervention for Back Pain | Rationale |
| Assess the patient’s severity of pain and create a treatment plan based on the assessment. | Back pain caused by a vertebral collapse or discomfort after a fracture are common complaints from patients. For the patient to participate in rehabilitation, pain management is important. |
| Implement fall protection measures and educate the patient on how to avoid injury. | Osteoporosis makes it harder to recover from falls and injuries since the bone doesn’t grow back as quickly. Assist with walking, get rid of any rugs or other potential fall hazards, and keep the walkway well-lit and uncluttered. |
| Stabilize the patient’s fracture if necessary. | Make sure the cast or splint fits the patient appropriately and monitor the skin’s integrity and circulation. |
| Observe the patient for indicators of a fat embolism and monitor the patient’s respiratory status. | Fracture complications such as fat embolism can cause respiratory failure. |
| Assist the patient in repositioning. | For some patients, positioning is challenging due to pain and injury. Help with mobility by helping to reposition every 2 hours as needed to prevent skin breakdown. |
| Encourage the patient to participate in range of motion exercises. | Muscle atrophy can be brought on by immobility. To avoid injury, assist with ROM exercises as needed. |
| Schedule the patient for physical and occupational therapy, as needed. | To retain functionality and mobility, consult a PT or OT for an assessment and rehabilitation. |
| Educate the patient about the prescribed pain management strategy, including the therapies, drug administration, side effects, and possible complications. | A greater patient awareness of the nature of pain, its treatment, and the role patient needs to play in pain control is one of the most important steps toward improved control of pain. |
| Provide the patient and the family enough information about chronic pain and the various pain management alternatives. | Lack of understanding of the characteristics of chronic pain and pain treatment techniques might increase the patient’s burden of pain. |
Back Pain Nursing Care Plan 2
Strain / Sprain
Nursing Diagnosis: Acute Pain related to pulled muscle secondary to strain, as evidenced by back pain, edema, guarding behavior, facial grimace, and restlessness.
Desired Outcomes:
- The patient will demonstrate the use of appropriate diversional methods and relaxation strategies.
- The patient will describe a desirable pain control.
- The patient will use pharmacological and nonpharmacological pain-relief methods.
- Patient will display an improvement in mood and coping.
| Nursing Intervention for Back Pain | Rationale |
| Evaluate the patient’s pain. Assess the location, features, onset, duration, frequency, quality, and intensity. | The most trustworthy source of knowledge on a patient’s pain is the patient who is actually experiencing it. Their ability to characterize the location, intensity, and duration of their pain makes their self-report the gold standard in pain evaluation. Thus, assessing pain through an interview aids the nurse in creating the best pain treatment plans. |
| Assess the severity of the patient’s pain using the Wong-Baker FACES Rating Scale. | The Wong-Baker Faces Rating Scale may be necessary for some patients since they are unable to relate to numerical pain ratings such as toddlers or clients with language barriers. Tools for measuring pain assist in converting a patient’s subjective perception of pain into numerical or descriptive measurements. |
| Provide the patient with an immediate pain relief solution before the pain becomes severe. | When a bigger dose of an analgesic may be necessary, it is advisable to give it before the pain starts or before it becomes severe. |
| Offer the patient alternative methods on relieving pain such as guided imagery, deep breathing, music therapy, directed meditation, massage and hot and cold compress application to the affected site. | Physical, cognitive-behavioral, and lifestyle pain treatment are nonpharmacologic approaches to pain management. Invoking a relaxation response lessens how pain is affected by stress. |
| Administer pharmacologic pain control medications to the patient as needed. | Pharmacologic pain treatment requires the use of opioids (narcotics), nonopioids (NSAIDs), and analgesic drugs. |
Back Pain Nursing Care Plan 3
Nursing Diagnosis: Impaired Physical Mobility related to chronic back pain secondary to arthritis as evidenced by inability to move, limited range of motion, decreased muscle control and body weakness.
Desired Outcomes:
- The patient will increase the function and strength of the affected body part.
- The patient will engage in physical activities independently within the parameters of activity limitations.
- The patient will demonstrate the use of adaptive modifications to promote ambulation.
| Nursing Intervention for Back Pain | Rationale |
| Assess and monitor the patient’s the level of joint pain and inflammation. | The degree of activity and exercise relies on how quickly the inflammatory process develops and resolves. |
| Advise the patient to maintain a chair or bed rest as necessary. Assist the patient in scheduling activities with frequent rest periods and uninterrupted night sleep. | In order to lessen fatigue and increase strength, systemic rest is necessary during acute exacerbations and important throughout the entire phase of the disease. |
| Help the patient in performing active and passive range of motion exercises, resistive training, and isometrics. | Maintains and enhances joint flexibility, muscle power, and overall endurance. While excessive activity can harm joints, inadequate exercise causes stiffness of the joints. |
| Encourage the patient to sit, stand, and walk with an upright, erect posture. | Maintains mobility while maximizing joint function. |
| Encourage the patient to carry out daily activities such as eating and dressing and maintaining an excellent hygiene. | To maximize function, ADLs that can be performed should be promoted. |
| Educate the patient about the use of safety measures such as the use of handrails in the shower, tub, and toilet, proper use of mobility aids, and wheelchair safety. | Aids in preventing falls and unintentional injury. |
| Reposition the patient frequently. Assist the patient in using mobility aids like a walker, cane, or trapeze to help demonstrate transfer skills. | Reduces tissue pressure and stimulates blood flow. Aids in patient independence and self-care. Skin shearing and abrasions are prevented by using proper transfer techniques. |
| Position the patient using a trochanter roll, pillows, and sandbags, use braces and splints to support the patient’s joints. | Minimizes contractures by maintaining correct joint position and body alignment and encouraging joint stability which lowers chance of injury. |
Back Pain Nursing Care Plan 4
Nursing Diagnosis: Activity intolerance related to chronic back pain secondary to severe scoliosis as evidenced by Reluctance to move, limited range of motion, fatigue and body malaise.
Desired Outcomes:
- The patient will verbalize increased tolerance in performing daily activities.
- The patient will exhibit energy conservation methods.
- The patient will preserve good body alignment.
| Nursing Intervention for Back Pain | Rationale |
| Determine the patient’s degree of physical mobility. | Understanding the specific level helps to create an effective management plan. |
| Assess the patient’s understanding and description of pain, and note the type, location, and intensity. | The discs, muscles, nerves, and ligaments in the spine are subjected to pressure and stress that can cause discomfort. |
| Encourage and teach the patient to use non-pharmacological pain management strategies such as imagery, relaxation, touch, and music. | By using these strategies, the pain will be lessened by diverting attention. |
| Encourage the patient to engage in active range-of-motion exercises. | Enhances blood flow, maintains strength, and tones muscles. |
| Encourage the patient to perform consistent postural exercises. | These exercises might aid in posture correction and scoliosis management. |
| Assess the patient’s capacity and tolerance for activity participation. | This data offers a starting point for care planning. |
| Schedule rest periods in between daily activities like eating, bathing, and walking. | The patient is able to conserve energy during rest periods. It enables breathing and heart rate to return to normal. |
| Encourage and teach the patient to use to brace as needed. | Utilizing a brace is mostly done to stop or delay the growth of the spinal curve. |
| Schedule the patient for a consult with physical therapist. | Corrective methods are used in physical therapy to stop curve advancement, allowing for ongoing maintenance and quality-of-life enhancement. |
| Provide assistance to the patient as little as possible, but as much as required. | Helping the patient when necessary and promoting independence as much as possible must coexist in harmony. The caregiver must modify the level of support given as the patient’s abilities change. Helping just when necessary is the best method to promote the patient’s independence and self-esteem. |
Back Pain Nursing Care Plan 5
Nursing Diagnosis: Acute Pain related to traumatic injury secondary to spinal cord injury (SCI) as evidenced by extreme back pain, paraplegia, muscle spasm and severe headache.
Desired Outcomes:
- The patient will report relief pain and discomfort.
- The patient will identify methods to manage pain.
- The patient will demonstrate use of relaxation techniques and diversional activities.
| Nursing Intervention for Back Pain | Rationale |
| Assess the patient, identify and measure the patient’s pain including the location, type and intensity on scale of 0–10. | Patient typically experiences pain in areas other than the area of injury, such as the chest, back, or maybe a headache from a stabilizer device. Muscle spasms and radicular pain, which is described as a searing or stabbing pain, may also be experienced by the patient after the spinal shock phase (associated with injury to peripheral nerves and radiating in a dermatomal pattern). After a SCI, this pain usually starts between days to weeks, but it can also last a long time. |
| Evaluate the patient for increased irritation, tense muscles, restlessness, and inexplicable changes in vital signs. | Nonverbal cues that indicate pain and suffering and call for action. |
| Offer comforting measures such as position changes, massage, range of motion exercises, warm or cold packs as necessary. | In addition to lowering the need for pain medication and its unfavorable effects on respiratory function, alternative pain management strategies are desirable for the patient’s emotional benefits. |
| Promote the use of relaxation methods such as guided imagery, visualization and deep-breathing exercises. As necessary, offer diversionary activities like television, radio, telephone, and limitless guests. | It refocuses the mind, encourages a sense of control, and helps to improve coping skills. |
| Administer medications as ordered such as analgesics and anxiolytics. | It might be preferred to reduce anxiety and encourage rest, as well as the discomfort and muscle spasms brought on by spasticity. |
| Help the patient determine the causes of back pain and other related symptoms. | Multiple variables such as anxiety, tension, external temperature extremes, sitting for long periods, bladder distension might cause or intensify burning pain and muscular spasms. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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