When is back pain a serious issue?

Woman stretching outside before a run

Back pain is an extremely common problem — just about everyone, at some point, is likely to seek medical care because of a back issue. If you’re experiencing back pain, you’re far from alone.

But when does back pain call for a visit to your primary care provider, urgent care or an emergency department? And when is it a sign of something serious? I’ll explain:

Symptoms to watch for along with back pain

There are several symptoms that can be associated with back pain that definitely signal the need for medical evaluation:

  • Numbness or tingling in the legs or other extremities
  • Muscle weakness
  • Bowel or bladder issues
  • Unexplained weight loss
  • Fever or night sweats
  • The kind of pain that wakes you up from sleep

These are symptoms that shouldn’t be ignored. If you’re experiencing back pain and any of these other symptoms, it’s worth calling your primary care provider or visiting an immediate care facility.

 

How to describe back pain accurately to your doctor, and why it’s important.

When to visit the emergency department for back pain

When back pain is accompanied by an inability to urinate or control bowel or bladder function, you should visit the emergency department.

Fever, too, accompanied by severe back pain, can be a sign of infection in a bone or spinal disc, and may need antibiotic treatment soon to keep the infection from progressing and causing other issues.

When it’s OK to try a “wait-and-see” approach

If you have back pain but you’re still able to function relatively normally and you don’t have any of the worrisome symptoms listed above, you can try resting and periodically taking an over-the-counter pain reliever, such as ibuprofen or acetaminophen (Tylenol). Modify your activity to limit bending, twisting and lifting. For many people, this is enough to significantly improve or even resolve back pain.

If, after six weeks, the pain hasn’t improved, then you should contact your doctor or other primary care provider to evaluate the cause of pain.

What happens once you seek medical care for back pain

After starting with their primary care provider for back pain treatment, many people will be prescribed a course of over-the-counter medication or even a short course of steroids, such as prednisone, to decrease inflammation. Many people will also be sent to some form of physical therapy, which can help with core strengthening and other back exercise.

After this first line of treatment, if they’re clearly not improving, it’s time to explore other forms of diagnosis and treatment. The path to treatment depends on individual symptoms, lifestyle and other variables, but it might involve an X-ray to get a deeper look at potential causes of pain. To look into causes of neurological symptoms, such as persistent numbness, tingling or shooting pain into the leg, the care provider might order an MRI.

Depending on imaging results or how the person responds to frontline treatment, they might be referred to a spine specialist like me. That’s where we use especially individualized approaches to treat back issues — depending on the root cause of pain, along with each person’s unique goals, lifestyle and other factors, treatment could involve steroidal injections, or surgery. Everyone is different, and it’s important to us that we treat you as a unique individual.

Common causes of back pain

The most common reasons patients see me — a spine specialist — are either disc herniation or a type of degenerative problem, such as degenerative disc disease. Both of these are typically treated through rest, anti-inflammatory medication and/or physical therapy. The vast majority of patients with these conditions will improve without surgery.

The bottom line

If you have fevers, an inability to control your bowel or bladder, and/or neurological symptoms along with your back pain — numbness, tingling, muscle weakness, etc. —then it’s important to seek medical attention. But back pain is a common problem that nearly always improves with rest, over-the-counter pain relief and, in the long-term, exercises to improve core strength and fitness.

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