Back pain is very common, and most cases are not serious. However, certain symptoms associated with back pain may indicate a more serious underlying condition that requires immediate medical attention.

When to Worry About Back Pain

• Persistent Pain Lasting Over Six Weeks
  • Significance: Chronic pain that does not improve with rest or typical treatments may indicate underlying issues, such as a herniated disc or spinal stenosis.
  • Evidence: Persistent pain is often a key indicator of the need for further imaging or specialist referral, as recommended by the American College of Physicians .
• Pain Associated with Fever, Weight Loss, or Fatigue
  • Significance: These symptoms may point to an infection (e.g., spinal abscess), inflammatory conditions (e.g., ankylosing spondylitis), or even malignancies like metastatic cancer.
  • Evidence: Studies show that back pain coupled with systemic symptoms warrants urgent investigation for infection or malignancy .
• Neurological Symptoms (Numbness, Tingling, or Weakness)
  • Significance: Numbness, tingling, or weakness, especially in the legs or around the groin, may signal nerve compression or conditions like cauda equina syndrome.
  • Evidence: Immediate assessment is advised when neurological deficits accompany back pain, as they may require emergency treatment to prevent permanent damage .
• Bladder or Bowel Dysfunction
  • Significance: Inability to control bladder or bowels can be a sign of cauda equina syndrome, a medical emergency requiring immediate intervention.
  • Evidence: Guidelines highlight bladder or bowel dysfunction as red-flag symptoms that necessitate urgent evaluation and, often, surgical intervention .
• Pain After Trauma
  • Significance: Back pain following an accident, fall, or other trauma could indicate fractures or internal injuries, particularly in older adults or those with osteoporosis.
  • Evidence: Imaging is recommended to rule out fractures or other structural issues when trauma is associated with back pain .
• Pain that Worsens at Night or with Rest
  • Significance: Pain that is more severe at night or doesn’t improve with rest could suggest malignancy, infection, or inflammatory conditions.
  • Evidence: Studies confirm that nocturnal pain or pain unrelieved by rest is associated with higher risk for serious underlying pathology .

Takeaway

While most back pain improves with time and self-care, it's essential to seek medical advice if you experience any of these red-flag symptoms. Early intervention can lead to better outcomes and prevent complications.

References:

Qaseem, A., et al. "Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline." Annals of Internal Medicine, 2017.

National Institute for Health and Care Excellence (NICE). "Low back pain and sciatica in over 16s: Assessment and management," 2020.

Deyo, R. A., et al. "Red flags for back pain," The New England Journal of Medicine, 2018.

Dr Geranmayeh