This month I want to credit our presenters with great topic selections, namely articles that will help us to consider our our approach to ED analgesics for acute back pain and maybe help us tighten our collective practices up a bit. In addition, we have included an article on digital nerve blocks which can provide us a jump-off point to expand our discussion on the use of nerve blocks and their inherent benefits and challenges. Acute low back pain is among the most common ED complaints, yet we seem to take very disparate approaches in our initial management. Usually, NSAIDS, benzos, steroids, narcotics, or oftentimes a combination of the above are commonly prescribed and unfortunately, can set expectations during future visits. The data in support of ‘keeping it simple’ appears to be growing and I will be interested in what your most effective approaches are to getting your patients buy-in. Nerve blocks, when they work, can be among the most rewarding procedures in EM and warrant developing an expertise in their application. That stated, nothing is more frustrating than a failed block after instilling a ‘huge amount’ of local anesthetic only to have a patient say “I can still feel it doc”. We look forward to having our nerve-block experts sharing your best pearls so if you are one, please come out.  Hope to see you there! Charlie   

 Friedman BW, et al., A randomized controlled trial of oxycodone/acetaminophen versus acetaminophen alone for emergency department patients with musculoskeletal pain refractory to ibuprofen. Acad Emerg Med. 2021 Aug;28(8):859-865. 

 Friedman BW, et al., Naproxen With Cyclobenzaprine, Oxycodone/Acetaminophen, or Placebo for Treating Acute Low Back Pain: A Randomized Clinical Trial. JAMA. 2015 Oct 20;314(15):1572-80. 

 Martin SP, et al., Double-dorsal versus single-volar digital subcutaneous anaesthetic injection for finger injuries in the emergency department: A randomised controlled trial. Emerg Med Australas. 2016 Apr;28(2):193-8.