When Is Lower Back Pain An Emergency
Most episodes of lower back pain eventually resolve on their own, but there are times when you should seek urgent medical attention. Some of these situations include:
- Patient is a child
- Pain is severe, constant, suddenly or progressively worsens, and/or doesnt go away
- Pain interrupts sleep
While some situations may warrant immediate intervention, most cases are not urgent and can be scheduled at a time convenient for the patient.
Your Pain Extends To Other Body Parts
If you’re experiencing severe back pain that is coupled with pain in other areas such as shooting pain down your leg then you should see a doctor. This could be a sign that you have sciatica, a form of pain that affects the sciatic nerve, which runs from the lower back and through the buttocks before branching down each leg. This condition usually results from a herniated disk. A doctor will be able to offer a variety of ways that you can relieve this pain.
When To Seek Medical Care For Low Back Pain
If lower back pain does not start to subside within one to two weeks, or if there are troubling symptoms, medical care should be sought. A health professional will first identify a general source of pain and then determine appropriate and effective methods of pain management.
Certain symptoms may indicate a medical emergency. While these conditions are rare, it is important to seek immediate medical attention should the any of the following symptoms accompany back pain:
- severe abdominal pain
Additionally, if back pain begins after an injury immediate medical care is warranted to check for damage to the spine.
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When Should You See A Doctor
You should consider seeing a health care provider if your lower back pain does not resolve with simple measures or if it is prolonged, as this could mean that there might be a more serious underlying cause.
Most people find significant improvement in their lower back pain within a month of home care. Each sufferer, however, is unique, and lower back pain can be a difficult condition to deal with. Many people have acute and subacute types of lower back pain and about 20%² will develop chronic lower back pain with symptoms persisting for a year.
Seek treatment as soon as possible if you are experiencing lower back pain alongside any of the following symptoms:
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Intense and prolonged pain
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Trouble walking or moving your legs
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Lack of bowel and bladder control
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Numbness or weakness, especially in the legs
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Other troubling symptoms
Your doctor will help determine the probable reasons for your lower back pain and provide appropriate treatment recommendations.
What Are The Most Common Lower Back Surgery Procedures
Spine surgery is not necessary for most people who have lower back pain. If you do need it, your doctor will recommend an appropriate procedure to address your specific symptoms and medical situation. Common spine surgeries include:
Spinal Fusion. Two or more vertebrae are permanently fused together to limit excess spinal motion. Your surgeon will use a combination of bone, bonelike material, screws, plates and rods to hold the vertebrae together so they can heal into a single unit. Spinal fusion may be done to correct spinal deformities or to increase the spines stability in severe cases of spinal osteoarthritis or herniated discs.
Laminectomy and laminotomy. Laminectomy is a surgery in which your surgeon removes the back portion of one or more vertebrae to create more space for the spinal cord or other nerves. In people with severe arthritis, bone spurs within the spinal canal can grow large enough to press on the spinal cord, causing pain and limiting mobility. In a similar surgery known as laminotomy, your surgeon will remove a small piece of bone called the lamina from the back of the vertebra.
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When To Contact A Medical Professional
- Back pain after a severe blow or fall
- Burning with urination or blood in your urine
- History of cancer
- Loss of control over urine or stool
- Pain traveling down your legs below the knee
- Pain that is worse when you lie down or pain that wakes you up at night
- Redness or swelling on the back or spine
- Severe pain that does not allow you to get comfortable
- Unexplained fever with back pain
- Weakness or numbness in your buttocks, thigh, leg, or pelvis
Also call if:
- You have been losing weight unintentionally
- You use steroids or intravenous drugs
- You have had back pain before, but this episode is different and feels worse
- This episode of back pain has lasted longer than 4 weeks
What Structures Make Up The Back
The lower backwhere most back pain occursincludes the five vertebrae in the lumbar region, which supports much of the weight of the upper body. The spaces between the vertebrae are maintained by round, rubbery pads called intervertebral discs that act like shock absorbers throughout the spinal column to cushion the bones as the body moves. Bands of tissue known as ligaments hold the vertebrae in place, and tendons attach the muscles to the spinal column. Thirty-one pairs of nerves are rooted to the spinal cord and they control body movements and transmit signals from the body to the brain.
Other regions of vertebrate are cervical , thoracic , and sacral and coccygeal segments.
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The Worst Back Pain Is Rarely The Scariest
People understandably assume that the worst back pain is the scariest. In fact, pain intensity is a poor indicator of back pain ominousness,10 and some of the worst causes are actually the least painful . For instance, someone could experience the symptoms of cauda equinae syndrome, and be in real danger of a serious and permanent injury to their spine, but have surprisingly little pain even none at all in some cases!
Meanwhile, many non-dangerous problems can cause amazingly severe back pain. A muscle cramp is a good analogy just think about how painful a Charley horse is! Regardless of whats actually going on in there, muscle pain is probably the main thing that back pain patients are feeling. The phenomenon of trigger points tiny muscle cramps, basically11 could be the entire problem, or a complication thats more painful and persistent than the original problem. Its hard to overstate how painful trigger points can be, but they are not dangerous to anything but your comfort.
Lower Back Pain Causes
Nonspecific low back pain means that the pain is not due to any specific or underlying disease that can be found. It is thought that in some cases the cause may be an over-stretch of a ligament or muscle. In other cases the cause may be a minor problem with a disc between two spinal bones , or a minor problem with a small facet joint between two vertebrae. There may be other minor problems in the structures and tissues of the lower back that result in pain. However, these causes of the pain are impossible to prove by tests. Therefore, it is usually impossible for a doctor to say exactly where the pain is coming from, or exactly what is causing the pain.
To some people, not knowing the exact cause of the pain is unsettling. However, looked at another way, many people find it reassuring to know that the diagnosis is nonspecific back pain which means there is no serious problem or disease of the back or spine.
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Types Of Lower Back Strain
There are two common types of soft tissue injuries in the low back:
- Muscle strain occurs when fibers in a muscle begin to tear from being overstretched or overused .
- Lumbar sprain occurs when ligaments are overstretched or torn. Ligaments are tough, fibrous tissues that connect bones together.
A specific diagnosis of ligament sprain or muscle strain is usually not needed, as both have almost identical symptoms and receive the same treatment. This article refers mainly to lower back muscle strains, but applies to sprains or other soft tissues injuries as well.
Persistent Low Back Pain
Nonspecific low back pain is classed as chronic if it lasts for longer than six weeks. In some people it lasts for months, or even years. Symptoms may be constant. However, the more usual pattern is one in which symptoms follow an irregular course. That is, reasonably long periods of mild or moderate pain may be interrupted by bouts of more severe pain.
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Looking At Two Kinds Of Back Pain
Lets talk about the most common forms of back pain: acute and subacute . Most of these cases are due to harmless causes. We lump them into the mechanical back pain diagnosis, which includes muscle spasm, ligament strain, and arthritis. A handful will be due to potentially more serious causes such as herniated discs , spondylolisthesis , a compression fracture of the vertebra due to osteoporosis , or spinal stenosis . Rarely, less than 1% of the time, we will see pain due to inflammation , cancer , or infection.
When someone with acute low back pain comes into the office, my main job is to rule out one of these potentially more serious conditions through my interview and exam. It is only when we suspect a cause other than mechanical that we will then order imaging or labs, and then things can go in a different direction.
But most of the time, were dealing with a relatively benign and yet really painful, disabling, and expensive condition. How do we treat this? The sheer number of treatments is dizzying, but truly effective treatment options are few.
When To Worry About Low Back Pain
And when not to! Whats bark and whats bite? Checklists and red flags and non-scary possible explanations for alarmingly back pain
The bark of low back pain is usually much worse than its bite. The pain almost always makes it seem worse than it is. Even when its unusually severe and/or constant, it probably isnt dangerous.
MRI and x-ray for low back pain are surprisingly unreliable,1 because things like bulging discs usually arent a big deal,2 most back pain goes away on its own,3 and trigger points are common and can be worrisomely intense but arent dangerous.4 Most patients are much better off when they feel confident about these things. The power of justified, rational confidence is a huge factor in back pain.5 Sadly, many healthcare professionals continue to perpetuate the idea of fragile backs,6 which undermines that valuable confidence.
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Back Pain Expert Philip Sell On The Questions To Ask
We asked Philip Sell, consultant orthopaedic and spinal surgeon, what he would want to know if he was suffering from back pain.
What is the cause of my back pain?In 85% of cases, were unable to be precise about why people have back pain. This can be frustrating. It may be more helpful to think about what you can do to make your back better quicker. Research has shown that occupational factors or physical factors only play a small part in back pain. Your genes are probably the most significant factor in back pain.
When should I visit my GP with back pain?See your GP as soon as possible if the back pain is combined with difficulty in passing urine or numbness between the legs or around the bottom. For people over the age of 55 with new back pain, a previous history of cancer surgery or loss of weight should also be medically checked as soon as possible.
Should I be resting?You may feel its the wrong thing to do, but keep mobile and active. Resting, bed rest in particular, can prolong the duration of an episode of back pain. Most acute episodes of back pain will settle on their own, often within days rather than weeks. Taking pain relief and keeping active will stop stiffness setting in and keep muscles in good condition.
When To See A Doctor
If the pain has not eased after 12 weeks, a person should see a doctor.
In some circumstances, a person may need to go to the emergency department or call 911. It is important to seek medical help if:
- a person hears a crack when they sustain the injury
- the injured part of the back is numb, discolored, or cold to the touch
- sit in a chair with lumbar support
The following tips may also be beneficial:
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Where Can I Get More Information
For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network at:
Office of Communications and Public LiaisonNational Institute of Neurological Disorders and StrokeNational Institutes of HealthBethesda, MD 20892
NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient’s medical history.
All NINDS-prepared information is in the public domain and may be freely copied. Credit to the NINDS or the NIH is appreciated.
Signs Your Back Pain Might Be An Emergency
In our 20s and 30s, normal back pain often can be attributed to factors of daily life, such as sitting too long, picking up children, or overdoing it while exercising.
In our 40s and older, work injuries and the beginnings of arthritis and degenerative conditions are more common.
Back pain is so common, in fact, that many patients shrug off symptoms that might indicate a medical emergency.
Approximately 80% of adults will experience back pain in their lives, so its important to be able to identify the severity of your symptoms and track how long the pain lasts.
If back pain can be associated with a specific activity, such as lifting or twisting wrong, and the pain goes away within 72 hours after resting and applying ice, its usually nothing to worry about. However, if pain creeps on gradually, appears suddenly, or doesn’t go away, you might have a more serious condition.
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How Is Back Strain Diagnosed
Unless pain has persisted for more than six weeks, diagnostic testing may not be needed. But if pain has persisted that long, it is important to rule out other things like a herniated disk. The following tests may be ordered by a doctor:
X-ray: Your doctor will look at the structure of your backbones and joints.
MRI: This 3D image is more specific than an x-ray. It can show the spinal cord, roots of the nerve, and soft tissue problems like enlargements or tumors.
Your doctor will also conduct a history and physical to see what exactly caused your strain.
Low Back Pain Fact Sheet
If you have had lower back pain, you are not alone. Back pain is one of most common reasons people see a doctor or miss days at work. Even school-age children can have back pain.
Back pain can range in intensity from a dull, constant ache to a sudden, sharp or shooting pain. It can begin suddenly as a result of an accident or by lifting something heavy, or it can develop over time as we age. Getting too little exercise followed by a strenuous workout also can cause back pain.
There are two types of back pain:
- Acute, or short-term back pain lasts a few days to a few weeks. Most low back pain is acute. It tends to resolve on its own within a few days with self-care and there is no residual loss of function. In some cases a few months are required for the symptoms to disappear.
- Chronic back pain is defined as pain that continues for 12 weeks or longer, even after an initial injury or underlying cause of acute low back pain has been treated. About 20 percent of people affected by acute low back pain develop chronic low back pain with persistent symptoms at one year. Even if pain persists, it does not always mean there is a medically serious underlying cause or one that can be easily identified and treated. In some cases, treatment successfully relieves chronic low back pain, but in other cases pain continues despite medical and surgical treatment.
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How Long Does Lower Back Pain Last & What To Do For It
Lower back pain is a condition that affects so many people. It is estimated that about 80% of adults do suffer from lower back pain at some point of their lifetime. This problem is a work related disability and a major cause of absenteeism in most working places. Lower back pain affects both genders and can be felt in different intensities ranging from dull persistent pains to sharp pains that can immobilize a person.
Factors like accident, age, lifting of heavy materials and sedentary lifestyles can cause lower back pains. However, a bigger percentage of low back pain is termed as mechanical and is linked to Spondylosis which is the general degeneration of the spine in connection to wear and tear in bones, discs and joints as you grow old.
You’re Running A Fever
The flu can definitely make you run a fever and achiness, including in your back. However, if the fever is unresponsive to standard OTC medications, you could have a serious infection that needs treatment immediately. If you go to a doctor and they find an infection, they may prescribe antibiotics and a few days rest.
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