Pain is our friendliest enemy -- it keeps us out of trouble even though it often seems to actually be the problem.
The body ‘locates’ pain near the surface quite well but has trouble indicating the source when the pain is deep. Pain from deep injuries, diseases or infections of organs, such as the heart, stomach, lungs and back may seem to come from somewhere else nearby or may radiate into multiple places. Intense pain may be more localizing but not always.
Therefore, when back pain is accompanied with other changes, fever, swelling, redness, heat, neurological problems or changes in body functions, the diagnosis may be sharper -- and the back pain diagnosis may be more serious.
Back pain arising from reversible problems usually goes away in hours or days, even if severe. If the back pain persists and is accompanied by other important changes, discussed below, the situation may be far more important or even dangerous.
There are many causes of back pain, several of which come from problems located more in the front of the body, such as in the abdomen or lungs. The milder backaches that one feels over one’s lifetime can generally be successfully managed by simple back pain treatments -- rest, medication, massage, the application of salves, exercise, weight loss and learning to put up with it.
When back pain is persistent and disabling, however, it indicates the need for a good diagnosis and sometimes for surgery. Back pain symptoms can be local or scattered, mild or severe and sometimes are a sign of a medical problem that requires medical attention and -- rarely -- may even be dangerous. Alternatively, the painful problem may be a simple nuisance but may actually require urgent medical attention.
More Back Pain Info
Visiting a Doctor for Back Pain
So, if the severity of back pain does not serve as a guide for when to see a physician, the question is how does one know? While there are exceptions, there are several generally accepted guidelines of when to see a doctor for back pain:
If the back pain has any of the following characteristics, it is a good idea to see a physician for an evaluation:
- Back pain that follows a trauma, such as a car accident or fall off a ladder
- The pain is constant and getting worse
- Back pain that continues for more than four to six weeks
- The pain is severe and does not improve after a day or two of typical remedies, such as rest, ice and common pain relievers (such as ibuprofen or Tylenol)
- The pain is worse at night (most common forms of back pain are alleviated by rest)
- Severe pain at night (e.g. pain that wakes one up from deep sleep)
- Abdominal pain that accompanies the back pain
- Numbness or altered sensation in the saddle area (upper inner thighs, groin area, buttock or genital area)
- Neurological problems, such as weakness, numbness or tingling in the leg(s) or arm(s).
Other Considerations with Back Pain
Other considerations that, when accompanied by back pain, may warrant medical attention:
- Back pain in individuals younger than 20
- Persistent back pain in individuals who have had or are currently being treated for cancer
- Individuals who have osteoporosis or osteopenia (weak bones)
- Individuals who are taking steroids
- Individuals who have a weakened immune system (e.g. HIV)
- If there is any obvious deformity of the spine that develops
- Blood in the urine, possibly burning during urination, along with one-sided back pain
A number of the above symptoms are described more fully below, including several situations that may not necessarily need to be seen in the emergency room but do warrant prompt medical attention.
Unexplained Fever with Increasing Back Pain
Fever (defined as a sustained temperature of more than 101° F in adults) can indicate an infection. Infections in the spine can arise gradually if one’s immune system has been weakened (e.g. HIV), or it can occur following spine surgery. Although relatively rare, spinal infections can give rise to an epidural abscess (a deep pus-filled pocket at or near the spinal dural sac) that can press on nerve structures, impairing motor skills. In some severe cases this can result in partial or near total paralysis. When a sustained fever occurs along with back pain it is advisable to see a physician for an evaluation.
Most wound infections that begin after spine surgery can be managed successfully with antibiotics when treated early, but in some cases the pus may need to be surgically drained. They are unusual but well known, occurring more frequently in patients having diabetes or poor health. Redness, pain and swelling may be seen around a wound that isn’t closing normally, along with the onset of fever and usually a clear discharge becoming yellow and thick. Good wound care almost always results in a good outcome.
A vertebral body bone infection (osteomyelitis) is most likely due to bacteria being transported from other parts of the body to the spine by veins. This may be a result of a procedure performed on the bowel or urinary tract, such as a colonoscopy or a cystoscopy, a diagnostic test using a thin telescope to inspect the bladder. This test is used when there is blood in the urine or before prostate surgery.
Other conditions that might lead to a vertebral body infection are intravenous drug abuse or long-term use of epidural steroids (e.g. to treat rheumatoid arthritis) and extensive dental procedures. Each of these procedures increases the chances of bacteria being introduced into the body.
Acute, Severe Upper Back Pain
Upper back pain that occurs suddenly, especially in people who have osteoporosis, is often an indication that a vertebral body in the spine has fractured and collapsed. Although this type of spinal fracture can be extremely painful, it is not a true emergency, but is often felt by the patient to be as there is often a great need to control the pain. It rarely has an accompanying neurologic effect.
Treatments to manage this acute back pain, and possibly to correct deformity caused by the fracture, are available and prompt evaluation by a spine physician is important.
Major, Unexplained Weight Loss with Back Pain and Neurological Impairment
Adult patients normally maintain the same body weight for years so when a sudden unintended weight loss (such as more than 5 pounds a week for a couple of weeks or more) or a loss of appetite for even favorite foods without apparent reason or depression occurs, the individual should quite soon consult his or her physician. This might indicate a serious underlying medical condition, such as a cancer. Ordinarily if a tumor is in or around the spine, even if it originated elsewhere, it might produce the following symptoms:
- Pain in the neck or back , followed by neurological problems (such as weakness or numbness in the arms, fingers, legs or toes, or a change in normal bowel or bladder habits)
- Back pain that does not diminish with rest, and pain that may be worse at night, even waking the patient from sleep, as compared with less pain in the daytime (which sometimes is associated with rheumatoid arthritis as well).
- The above symptoms accompanied by a loss of appetite with unplanned weight loss, perhaps with nausea and vomiting.
Evaluation by a physician, and possibly an X-ray or scan imaging plus certain blood tests, will most likely be needed as primary steps in identifying the causes of these various symptoms.
Finally, there are a few symptoms that do warrant going to the emergency room and/or immediately being evaluated by a physician.
Acute Back Pain with Abdominal Pain
Acute (meaning quick onset) lower back pain that did not necessarily begin with an obvious injury nor is related to back or spine movement can be a symptom of a tearing of the aorta (large artery) in the abdomen, called an abdominal aortic aneurysm. Then, if this large vessel ruptures with major internal bleeding the situation can be life threatening or fatal. The earlier symptoms of an aortic aneurysm are typically felt as an unremitting sharp and crushing pain in the low back and abdomen, severe enough to prevent being able to stand up straight. The individual is then literally doubled over in pain.
Progressive Leg Weakness and/or Uncontrolled Bladder and Bowels
Sudden inability to control one’s bladder and/or bowel and/or progressive weakness in the lower extremities (leg or foot) can be an indication of a rare but serious condition called cauda equina syndrome. Anyone experiencing these symptoms should seek immediate medical attention. Typical symptoms of Cauda equina include:
- Altered sensation, or severe or progressive weakness or numbness in the lower extremities - the legs and/or feet
- Loss of sensation or altered sensation in the "saddle" area (the area or your body that would sit on a saddle: inner thighs/between the legs, genital area, buttocks, back of legs)
- Inability to control the bladder or bowels (including retention or incontinence)
- Pain, numbness or weakness in one or both legs that may cause difficulty walking
Cauda equina syndrome is caused by the compression of nerves in the lumbar spine, which can happen from a trauma to the spine, any spinal condition that may compress the lumbar nerves, or an infection. Left untreated, this syndrome can ultimately result in paralysis, as well as continued loss of sensation in areas below the lower spine.
While the above described symptoms and possible conditions may seem alarming, it is important to remember that the vast majority of back pain is not harmful in and of itself and will usually get better in several weeks. If back pain is experienced without any of the symptoms described above, there is a good chance that the back pain is “mechanical." This type of back pain is usually related to some type of physical activity or posture that has stressed the back and will typically get better on its own and will respond to simple pain remedies, such as up to one or two days of rest, acetaminophen, ibuprofen, ice and/or heat application, followed by gentle stretching.
The bottom line that everyone should remember is that if one is in doubt, consult a back pain doctor. And with back pain, generally if it is progressive, does not respond to rest and simple pain remedies, and/or involves neurological impairment then it is definitely a good idea to be evaluated by a physician.