Back pain can often be severe even when resulting from a relatively mild injury or spinal condition. But when can back pain become an emergency? Several key symptoms – which may signal dangerous or even life-threatening problems – should spur patients to seek immediate medical attention, according to Kaliq Chang, MD, of Atlantic Spine Center.
With 8 in 10 people experiencing low back pain at some point in their lives, it should be no surprise if this highly common situation erupts after an injury – such as a fall, sports mishap, or auto accident, Dr. Chang says. Other prevalent causes of back pain include osteoarthritis in the spine or back conditions such as spinal stenosis or herniated vertebral discs.
“The bad news is that back pain happens to most of us, but the good news is that most cases are highly treatable with home remedies such as over-the-counter pain relievers, heat or ice, or rest, and resolve in a matter of weeks,” says Dr. Chang, a highly specialized interventional pain management specialist. “Back pain can seem much worse than the problem causing it – it can feel serious even when it’s not. Rarely, however, back pain indicates an alarming cause.”
Tips on symptoms you shouldn’t ignore – and why
Since the intensity of back pain isn’t always a reliable sign of its seriousness, Dr. Chang explains symptoms you shouldn’t ignore and the conditions they may point to. These include:
Progressive leg weakness and/or loss of bladder or bowel control: If you’re losing sensation and strength in your legs and feet – and especially if it’s creeping to the “saddle” area in your groin and buttocks – you may have cauda equina syndrome. This condition, typically due to severe compression of the entire nerve sac in the lower spine, can result in leg paralysis and loss of bowel or bladder control – perhaps permanently – and may be treated with emergency surgery. “Those with cauda equina syndrome may have difficulty walking without stumbling, or may find themselves unable to walk at all, because of pain, numbness or weakness in one or both legs,” Dr. Chang says. “These symptoms typically come on relatively quickly and are extremely noticeable.”
Unexplained, rapid weight loss joined by pain and neurological problems: Pain in the neck or back that occurs with noteworthy other symptoms – including rapid, unexplained weight loss and weakness or numbness in the arms or legs – may indicate a spinal tumor. This condition, diagnosed with tests such as CT imaging and/or blood tests, can produce back pain that doesn’t get better with rest and may worsen at night, Dr. Chang notes. A change in normal bladder or bowel habits may also be noticeable. “Any of these symptoms can be accompanied by loss of appetite, nausea and vomiting, or fever and chills,” he says.
Severe abdominal pain joined with low back pain that make standing straight impossible: Low back doesn’t often wrap around to the abdominal area. But if it does, it could actually indicate a highly dangerous condition known as an abdominal aortic aneurysm – a dangerous ballooning of the aorta, the largest artery in the body. “If an abdominal aortic aneurysm bursts, it can lead to massive internal bleeding and prove fatal,” Dr. Chang says. “Rapid-onset, sharp pain in the lower back and abdomen that is so acute that a person can’t stand up straight can signal this emergency condition.”
Fever along with increased back pain not responsive to fever-reducing medications: When a fever of 101 degrees or higher in adults – which doesn’t go down after taking fever-reducing drugs – is accompanied by severe back pain, this can signal a spinal infection. “While rare, spinal infections can press on nerves in the spine and cause not only pain, but paralysis,” Dr. Chang explains. “Infections can occur after a surgical procedure, invasive diagnostic test or other situations that introduce bacteria into the bloodstream.”
Pain not always top clue of emergency
Some of the most perilous emergency back pain scenarios don’t always include severe back pain, Dr. Chang points out. Cauda equina syndrome, for example, causes surprisingly little pain despite leaving those affected in danger of permanent injury to their spine and long-term paralysis.
One additional back pain emergency includes feeling weakness or numbness in a leg or arm or so-called “foot drop,” in which you can’t properly lift your toes off the ground because muscles in the foot and leg are too weak to raise the foot while walking. This situation suggests nerve damage in the spine requiring immediate medical attention.
“In all of the scenarios discussed here, don’t wait to see if symptoms go away,” Dr. Chang advises. “All are red flags and it’s important to see a doctor right away.”
Kaliq Chang, MD, is an interventional pain management specialist board-certified in anesthesiology at Atlantic Spine Center.