Louise Chang, MD
How do you know when that achy pain in your back is more than you can handle alone? Experts agree -- if your back pain is in conjunction with any of the following symptoms, skip the at-home remedies for in-office help.
There are several red flags that doctors look for when evaluating low back pain.
The purpose of these warning signs is to detect fractures, tumors, or infections of the spine. If you have any of these red flags along with back pain, see your doctor as soon as possible.
Sure, your back just could be achy and tight from the flu, but an unresponsive fever accompanied by back pain also could be a sign of a serious infection. “It’s indicative of something more systemic,” says orthopaedic surgeon Richard Guyer, MD, founder of the Texas Back Institute and Associate Clinical Professor of Orthopaedics at the University of Texas Southwestern Medical School.
What to expect: Your primary care doctor can rule out an infection. If it is an infection, antibiotics may be prescribed. If your doctor rules out an infection, a couple days of rest can be helpful. Sometimes back pain can be a result or a secondary consequence of an infection causing the fever. But once you start to feel better, doctors typically recommend slowly resuming your daily activity. Resting more than a day or two can actually make your back pain worse.
If you've had a serious trauma -- such as a fall from a height or a car accident -- or if you've had a relatively minor trauma and you're over 50, your doctor will want to take a serious look at your back pain. Even falling down a few steps when you're older can cause a fracture.
What to expect: Your doctor will probably take an X-ray to look for fractures. If no fractures are found, you may manage your pain with medication and later your recovery with physical therapy.
Numbness or Tingling
You might think that you can stop numbness or prickly tingling with over-the-counter medication, but this is usually an indication of nerve irritation or damage and is clinically more significant than your typical pain, says New York City chiropractor Todd Sinett, author of The Truth About Back Pain. If that pins-and-needles feeling won’t go away, you may be experiencing one of several conditions -- such as a herniated disc, spinal stenosis -- that can cause nerve pressure. “If left untreated, prolonged nerve irritation and damage can lead to permanent disabilities,” says Sinett.
What to expect: It would be smart to first see your primary care doctor for an evaluation. Treatment will vary depending on the diagnosis. Additional testing to image the spine and check nerve conduction may be ordered.
Loss of Bowel or Bladder Function
Back pain teamed with a loss of bowel or bladder control can be a telltale sign of a rare, but serious condition called cauda equina syndrome, in which the nerve roots in the lower end of the spinal cord have experienced some sort of compression and become paralyzed. This can happen as a result of a herniated disk, fracture, tumor, spinal stenosis, or trauma to the spine. Symptoms can develop over time and also include numbness and weakness of the legs. Cauda equina syndrome is a medical emergency and requires immediate attention.
What to expect: In order to relieve the pressure that is damaging nerves and preserve nerve function, "Your doctor will perform a procedure called a surgical decompression," says Guyer.
Medical history of cancer, suppressed immune system, osteoporosis, or chronic steroid use
A history of cancer would make your doctor want to rule out cancer spread as a possible cause for your back pain. Immune suppression could lead your doctor to suspect an infection as the cause of your back pain. A history of osteoporosis or chronic steroid use could lead your doctor to suspect a fracture as the cause of your pain.
What to expect: Your primary care doctor may order tests such as blood work or an MRI to check for a tumor or infection or X-rays to rule out fractures. You may take antibiotics for an infection. Fractures can be treated with medication, physical therapy, and sometimes surgery. Pain management for cancer that has spread to the spine may include medications and radiation therapy.
If, while walking, your toes drag along the ground or you have to consciously lift your foot higher to compensate for the dragging, you may be experiencing foot drop, a condition that can be accompanied by back pain, says Sinett. Foot drop is usually a symptom of a greater issue like a nerve problem (the nerve that tells muscles to lift the foot may be damaged), muscle problem, or a brain problem.
What to expect: The first thing your doctor must do is figure out the underlying cause of the foot drop. For example, if your doctor suspects a herniated disc, she may suggest treatments such as physical therapy and steroid injections.
All is fine during the day, but as soon as your head hits the pillow your back starts to hurt, making sleep near impossible. Sound like you? “Pain that wakes you up in the middle of the night can be the sign of disc degeneration or a sprain, or something more serious like cancer or a tumor,” says Sinett. Bottom line: Night time back pain shouldn’t be ignored. Make a doctor’s appointment as soon as possible.
What to expect: Your primary care doctor may order tests like blood work or an MRI to check for infection or tumor.
Unexplained Weight Loss
When you have unexpected and unexplained weight loss, your doctor may want to rule out infection and tumors as possible causes for your back pain.
What to expect: Your primary care doctor may order tests such as blood work or an MRI to check for infection or tumor. If these tests are negative, you may be given pain medication and other tests may be performed to see if there is another underlying cause for your weight loss. You may also receive pain medication and physical therapy for your back pain.
Prolonged Pain (6+ weeks)
Because 90% of back pain cases get better within six weeks, your doctor will want to investigate more serious underlying causes if your pain is still severe after that much time passes.
What to expect: After an evaluation of your symptoms and a physical exam, your primary care doctor may order blood work and imaging tests to help determine a diagnosis.
When you're over 70, there's an increased risk for infection, tumors, and abdominal causes of back pain.
What to expect: Your doctor may perform diagnostic tests including blood work and imaging to rule out underlying causes of your pain.
IV Drug Use
People who have prolonged use of IV drugs are more susceptible to infection.
What to expect: Your doctor will mostly likely order blood work to rule out infection. If an infection is found, you'll take antibiotics in addition to pain medication.
SOURCES:American Academy of Orthopaedic Surgeons.Harding, I. Spine, September 2005; vol 30: pp 1985-1988.Richard Guyer, MD, founder of the Texas Back Institute and Associate Clinical Professor of Orthopaedics at the University of Texas Southwestern Medical School.Todd Sinett, chiropractor and author of The Truth About Back Pain, New York, NY.National Institute of Neurological Disorders and Stroke, National Institutes of Health: "NINDS Foot Drop Information Page," "Low Back Pain Fact Sheet."Siemionow, K. Cleveland Clinic Journal of Medicine, August 2008; vol 75: pp 557-566.emedicinehealth: "Cauda Equina Syndrome," "Back Pain."University of Michigan Health System: "Acute Low Back Pain."
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