Urgent Cases and When to Go to the ER for Back Pain
Let me reassure you that less than 1% of all causes of back pain are true emergency situations. The problem is that it can be difficult to identify who that 1% is for most people. It’s useful also to understand the different kinds of back pain emergencies and what they mean so you can figure out how you should proceed.
There are a couple of reasons that a cause of low back pain could be an emergency. This post overviews these causes and when to go to the ER for back pain.
When Trauma to the Back is the Source of Pain
The pain is a sign of something really terrible happening that needs attention immediately. If immediate attention is not given, then things could get worse. There are 4 causes of low back pain which fit into this category:
Fractures in our back are most commonly from underlying osteoporosis, which means severely decreased bone mineral density. Osteoporosis is more common in females, after menopause, in whites/asians, when there is a family history, and with older age in general. When someone has osteoporosis it does not take much to cause a fracture in your back. For example, I have had patients who bent over while they were gardening that then ended up having a fracture. These fractures are considered emergencies in my mind for a couple of reasons.
If no one recognized the fracture you will continue to do activities that could worsen the fracture, create new fractures, or worsen your pain.
The fracture itself could result in bone fragments being pushed back into the spinal canal which could cause pressure on the spinal cord or spinal nerves which could cause permanent nerve damage.
2. Cauda Equina Syndrome
This syndrome refers to significant pressure on the spinal nerves resulting in a constellation of symptoms including bowel or bladder incontinence, numbness in the groin, and weakness in the legs. If the pressure on the nerves is not released, the nerves could be permanently damaged resulting in weakness and bowel/bladder difficulties.
Infection can either start in the spine or spread to the spine. The infection could be in the bone (osteomyelitis), the disc (discitis), or in the epidural canal (epidural abscess). Once inside the spine, the infection can grow and put pressure on the spinal nerves or spinal cord which could cause permanent nerve damage. Also, the infection could easily spread to the brain resulting in infection of the brain. Needless to say, the infection can result in death or permanent disability if it is left untreated.
Cancer or a tumor can start in the spine but more commonly it ends up in the spine after spreading from a different starting point. The tumor could put pressure on the nerves or bone and this could result in pain and eventually in nerve damage. Additionally, the cancer can continue to grow and it can destroy bones in the process or spread to other areas. Left untreated or unrecognized, the cancer could lead to death or permanent disability.
To determine if you have one of the above emergency conditions, you can ask yourself the following questions (These are the same questions I ask my patients.):
- Have you had any loss of control of bowel or bladder function?
- Have you had progressive weakness in your legs?
- Have you had numbness in your groin area?
- Have you had unintentional weight loss in the past 6 months (20-30 pounds)?
- Have you had fevers or chills that come and go without explanation?
- Do you have low bone mineral density (osteoporosis) and have you had a minor fall or injury resulting in severe pain in your low back?
- Low bone mineral density risk factors: older age (50+), female gender, family history of osteoporosis, menopause, white/asian race,
- prior history of height loss or prior osteoporotic fracture)
When Trauma to Another Organ System is the Source of Pain
The pain is in the low back but it’s actually coming from another organ system and medical attention is needed to figure out what is actually causing the pain so this organ system or process can be treated.
Not all back pain comes from the structures of the low back. Many other organ systems in the body can refer pain to the low back. So while you are thinking that your low back is hurting it could actually be your kidney that’s suffering.
These are the different kinds of organ systems that when affected could cause someone to feel low back pain:
- Blood vessels: Abdominal aortic aneurysm
- Gastrointestinal system: Pancreatitis, peptic ulcer disease, cholecystitis (inflamed gallbladder)
- Skin: Shingles rash
- Pelvic organs: Endometriosis, pelvic inflammatory disease, prostatitis
- Kidney: Kidney stones, pyelonephritis (infection of kidney)
Many of the above conditions require urgent or emergent medical attention otherwise that process could get worse and lead to more serious damage to that organ system or it could result in death.
To figure out if you might have one of these other organ systems causing your low back pain ask yourself the following questions:
- Do you have abdominal discomfort?
- Do you have nausea or vomiting?
- Is your pain related to eating? For example, does the pain begin 30 minutes after eating?
- Is the pain associated with a rash on your back or leg?
- Do you have discomfort in your pelvis?
- Do you have discomfort in your flank?
- Do you have a fever or chills?
- Do you have pain with urination?
Getting Help for Your Back Pain
If you think your symptoms match up with either of the above two categories, it would be best to visit with your doctor or go to the emergency department to get evaluated. If your symptoms don’t match up with either of the above, then you should probably consider visiting with a doctor if your pain does not show a trajectory of improvement. This would allow you to get some reassurance that there isn’t something else causing your pain and that you will indeed get better.
Step 3: What are some at home back pain remedies?
After identifying the type of pain you have and whether or not your back pain is an emergency, you’ll want to find ways to manage your pain. Next up: Learn some things you can do for pain at home to find relief.