When is back pain an emergency?

SUSAN LOCKE helps readers understand when low back pain is and isn’t an emergency . . .

Most cases of low back pain don’t require urgent care, but patients should seek a doctor immediately if they experience low back pain as a result of severe trauma, or if low back pain is accompanied by any of the following four situations.

1. Progressive leg weakness and/or loss of bladder or bowel control. These symptoms may be “cauda equina” syndrome where there is severe compression of the nerves in the lower spine. Left untreated, cauda equina syndrome can result in permanent paralysis, loss of sensation in the areas below the lumbar spine and loss of bladder/bowel control.

2. Unexplained weight loss, loss of appetite, pain and neurological problems. These symptoms may be indicative of a spinal tumor.

3. Severe, continuous abdominal and lower back pain. This could be symptoms of an abdominal aortic aneurysm.

4. Sustained fever and increased pain. These symptoms are consistent with spinal infection (osteomyelitis).

A diagnosis will typically classify the patient’s condition as one of three types of pain. Patients can experience one type, and based on the progression of their condition, may experience another.

• Low back pain, the most common type of back pain, is confined to the lower back only and does not travel into the buttocks or legs. The pain may be sharp or dull and may be severe enough to limit everyday activities. Pain may worsen with certain activities (such as sports) or physical positions (such as sitting for long periods) and is relieved by rest. Most low back pain is acute (short-lived and heals within six to 12 weeks).

• Sciatica is the second most common type of pain caused by a lower back problem. Caused by conditions that compress the nerve roots of the sciatic nerve, the pain is more severe in the leg than in the back. Symptoms are pain, numbness and/or weakness in the lower back and on only on one side of the lower body, affecting the buttock, leg, foot, or the entire length of the leg.

• Low back pain with referred pain that radiates to the groin, buttock and upper thigh, but rarely below the knee. Patients describe the pain as dull and achy with varying intensities. Low back pain with referred pain is similar to axial pain and is managed with similar treatments.

Treatment for lower back pain depends upon the patient’s history and the type and severity of pain. The vast majority of lower back pain cases get better within six weeks without surgery, and lower back pain exercises are almost always part of a treatment plan.

If pain persists or worsens, more involved diagnostic and surgical procedures may be recommended. Rest for a few days to allow injured tissue and nerve roots to begin to heal. Heat and ice packs help relieve most types of low back pain by reducing inflammation. Over-the-counter medications and prescription medications are available to help reduce symptoms of lower back pain.

SUSAN LOCKE, MD, is Healthnetwork Foundation’s medical director.

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