Is My Back Pain Serious? The Warning Signs That Need Same-Day Care

Most back pain is not dangerous. A few symptoms are, and they are worth knowing before you need them.

Most back pain comes from muscles, joints, or discs, improves within days to weeks, and does not need a scan or a specialist. A small number of symptoms signal something more serious: pressure on the nerves or spinal cord, an infection, a fracture, or a problem outside the spine. This guide sorts symptoms into four levels, from "go to the emergency department now" to "give it some time," so you know what to do.

If you are ever unsure, it is always reasonable to get checked.

Go to the emergency department now

Call 911 or go to an emergency department if you have back pain with any of the following:

• New loss of bladder or bowel control, or new difficulty urinating
• Numbness in the groin, genitals, buttocks, or inner thighs (the area that would touch a saddle)
• Weakness in one or both legs that is getting rapidly worse, such as your foot slapping the ground or your legs giving way
• New weakness or numbness in your arms or legs after a fall, a car accident, or another injury
• Sudden, severe pain in the back or abdomen with lightheadedness, fainting, or a racing heart. This can be a sign of a problem with the aorta, the body's main artery, and is a medical emergency.
• Back pain with chest pain or shortness of breath

The first three can be signs of cauda equina syndrome, where the bundle of nerves at the base of the spine is severely compressed. It is rare, but it needs surgery quickly, and delay can lead to permanent problems with bladder, bowel, and sexual function. Do not wait for an appointment.

Call your doctor today

Contact your doctor the same day, or go to urgent care, if you have back pain with:

• Fever or chills, especially if you feel generally unwell. The risk of a spinal infection is higher if you inject drugs, have had a recent infection or spine procedure, or have a weakened immune system.
• Burning with urination, blood in your urine, or pain in your side, which can signal a kidney problem rather than a back problem
• Sudden, sharp pain after a minor fall, lift, or even a cough, if you are older or have osteoporosis. This can be a vertebral compression fracture.
• Significant weakness, such as foot drop, even if it is not getting worse quickly

Make an appointment soon

Book an appointment within a week or two if you have:

• A history of cancer and new back pain, particularly pain that is constant or worse at night. Call sooner if the pain is severe or you have any weakness. See metastatic spine disease.
• Unexplained weight loss along with back pain
• Pain that wakes you at night and does not ease when you change position
• Pain that is steadily worsening over weeks rather than slowly improving
• Gradual clumsiness in the hands or unsteady walking, such as dropping things, trouble with buttons, or needing handrails more. This can be pressure on the spinal cord in the neck (cervical myelopathy), which often causes little pain. See our article on clumsy hands and unsteady walking.
• Leg or arm pain, numbness, or tingling that has not improved after a few weeks
• Back pain that has not improved after about four to six weeks of reasonable self-care

These do not usually mean something serious is happening, but they are reasons to be examined rather than to keep waiting.

Usually fine to manage at home

Most back pain falls here. It is probably safe to manage at home for now if:

• The pain started after activity, lifting, or sleeping awkwardly, or with no clear cause
• It changes with movement and position
• You have no numbness, weakness, or bladder or bowel changes
• You feel generally well otherwise
• It is gradually improving, even if slowly

What helps:

• Keep moving. Gentle activity such as walking usually helps more than rest. Bed rest can slow recovery.
• Heat can ease muscle pain and stiffness.
• Over-the-counter pain relievers may help, used as directed on the label and if they are safe for you. Ask a pharmacist or your doctor if you have other health conditions or take other medications.²
• Give it time. Most episodes improve significantly within a few weeks.

You usually do not need an MRI or X-ray right away. Without warning signs, early imaging generally does not change treatment for typical back pain.¹ Imaging becomes useful when warning signs are present, or when symptoms have not improved and treatment decisions depend on it.

If the pain changes, and any of the warning signs above appear, move up to the matching level.

Why warning signs are not a diagnosis

Having one of these symptoms does not mean something serious is happening. Most people with night pain or back pain over age 50, for example, turn out to have a common, benign cause. The warning signs are reasons to be examined, not conclusions. Equally, their absence does not guarantee everything is fine. If your back pain feels different or wrong to you, trust that and get checked.

Dr. Adapa's approach

Most people with back pain never need surgery, and many never need a specialist. Dr. Adapa's role is to identify the smaller number of problems that need prompt treatment, and to reassure the far larger number who do not. For urgent symptoms, go straight to an emergency department. For warning signs that need a timely look, the office can help you be seen quickly.

Read next

• Low back pain
• Lumbar herniated disc
• Osteoporotic compression fracture
• Spine infections
• Metastatic spine disease

Sources

1. Chou R, Qaseem A, Owens DK, Shekelle P. Diagnostic imaging for low back pain: advice for high-value health care from the American College of Physicians. Annals of Internal Medicine. 2011;154(3):181-189.
2. Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine. 2017;166(7):514-530.