Back Pain: When To Contact Your Doctor
Back pain, in general, is very common and often interferes with a person’s quality of life. It may involve the neck area, upper back, lower back, or the entire back. However, back pain from serious causes is uncommon. In fact, less than 1 out of 100 people who go to their doctors with back pain have a serious problem.
Goodpath is able to help most people with back pain. A person completes our back pain assessment. They answer questions about their back pain symptoms, health history, and lifestyle. From the answers, our medical team creates a personalized program.
There are times when a person’s back pain assessment answers suggest something else. Certain responses mean: the person should contact their doctor and make an appointment; at times they should get an urgent appointment; and, rarely, they should get emergency medical care.
When assessment answers suggest a person should get medical care other than ours, that is exactly what Goodpath’s medical team recommends.
Serious Back Pain
Medical experts recommend a person should contact their doctor when they have back pain along with certain signs and symptoms and/or a history of specific medical conditions. The doctor can:
Ask about the person’s medical history
Complete a physical exam
Order diagnostic tests, like imaging or lab work
Make a referral to a specialist
Suggest procedures or surgery
Causes & Conditions
The following information describes causes, conditions, and other factors that when associated with back pain may mean a more serious condition.
In each instance, we provide important information about the condition, such as symptoms and tests or treatments that might be done.
This helps each individual make an informed decision about seeking medical care. Again, Goodpath’s back pain assessment is designed so that those who have serious indicators, get medical care.
1. Back Pain With Treatment/No improvement
A person should contact their doctor again, if they have been following a prescribed treatment plan for three months, without any improvement. If a follow-up appointment is not already scheduled, they should call their doctor’s office.
Continued pain, trouble with movement, difficulty with daily activities
The doctor will ask questions about the pain and compare it to notes from previous visits. They will also examine the person, asking them to move into different positions, if possible.
If the person has not had imaging for this episode of back pain, when first seeing their doctor, X-rays or scans may be ordered. They may have repeat or another type of imaging if they have different or worsening symptoms.
The doctor may recommend that they continue with previously prescribed treatment. Or, they may change the current treatment, or add something else to it. They may also refer the person to a specialist for further evaluation and treatment. A follow-up visit will be scheduled.
2. Severe, Acute Back Pain
Anyone with acute, very severe back pain that doesn’t go away should get medical care right away. A person may need to go to a nearby emergency department or call 911 for help.
This type of pain is acute which means it started suddenly - over minutes or hours. It is the type of pain that makes it difficult to talk, move, and breathe. And, it doesn’t lessen or stop.
A doctor will ask questions about the pain and perform an exam. They will also ask about the person’s medical history to help figure out the cause.
With pain this severe, a person may be given short-term pain medicine. X-rays or scans are often ordered. Blood or urine tests may also be done. The doctor may also refer the person to a specialist.
A diagnosis may not be determined right away. One common cause for sudden, severe back pain, for example, is a fracture of one of the bones of the back (vertebrae).
Treatment depends on the likely diagnosis. It may include additional pain or other medicines, gentle movements, or physical therapy.
3. Severe/Progressive Neurologic Deficit
Weakness, tingling, or numbness of the arms or legs (a neurologic deficit) is due to pressure on (compression) one of the nerve roots. This is the area (foramen) where a spinal nerve goes from the spinal cord through one of the bones of the spine (vertebrae). Or, it may be from pressure on the spinal cord itself.
The cause of nerve root or spinal cord compression may be: a spinal disc that is out of position (herniated disc); a narrowing of the area around a nerve as it passes through one of the bones of the spine (foraminal narrowing); or from pressure on a nerve inside one of the bones of the spine (spinal stenosis). Any of these changes may also put pressure on the spinal cord.
A person may not have symptoms. Or they may have symptoms that are mild or moderate and unchanging (stable). However, when symptoms are severe or getting worse (progressive), then a person should contact their doctor for an urgent medical appointment.
The symptoms of a severe or progressive neurologic deficit include severe back pain, as well as severe or worsening muscle weakness, tingling, numbness, loss of sensation, or unusual sensations down their arms or legs, and bladder or bowel problems.
A person with pressure on the spinal cord in the neck may also have a sudden shock-like feeling in the back of the neck and down the arms and legs when bending the head forward (called Lhermitte's sign).
A person with symptoms of a severe or progressive neurologic deficit will have an immediate MRI scan or computed tomography (CT) myelogram and an urgent referral to a specialist. Treatment may include a trial of physical therapy, steroid injections, or surgery.
Surgery, to relieve pressure on the spinal cord may be necessary. Having surgery as soon as possible helps to prevent lasting neurologic symptoms.
Some individuals are at an increased risk of breaking one of the bones of the back (vertebral compression fracture).
One significant risk factor is osteoporosis, when bones become weak and brittle. The vertebrae of the upper back are most often affected.
Women past menopause are much more likely to have osteoporosis. Tobacco use, long-term or frequent steroid medicines, and excessive alcohol use also increase the chance of a vertebral fracture.
Some people have little or no pain, however, when severe pain is associated with a possible vertebral fracture, a person should contact their doctor as soon as possible.
A fracture of one of the vertebrae may include sudden, severe pain and difficulty with movement. The pain may wrap around the side or front of the body. When examined, there is often pain and tenderness over the area of the fracture.
Upon seeking medical attention, a person will usually have an X-ray of the area of the back with pain.
If the underlying cause of the fracture is osteoporosis, then treatment includes medicines, exercise, and diet changes to improve the strength of the bones. If other risk factors are present, then those are addressed. Additional treatment may include pain medicines (by mouth or injection), bracing, as well as surgery.
5. Severe Curvature Of The Spine
A person born with severe curvature of the spine (congenital scoliosis or kyphosis) may have worsening back pain due to growth, injury, or other causes. If the person has a change in back pain they should contact their doctor.
Worsening or changing back pain.
A person with severe scoliosis or kyphosis may need imaging tests. And they may have physical therapy, bracing, or referral to a specialist. Surgery is also a possibility.
6. Inflammatory Rheumatologic Conditions
Inflammation is the body’s immune system reaction to infection or injury. Many conditions involve the immune system; some of them are also rheumatologic. These are conditions that affect the musculoskeletal system. Rheumatologic conditions may involve the joints, muscles, cartilage, tendons, or ligaments, including those structures in the back.
Inflammatory rheumatologic conditions cause musculoskeletal problems, but they also affect other parts of the body or even the whole body. Without treatment they often get worse over time.
Some have certain risk factors. For example, ankylosing spondylitis (AS) is most common in men less than 40 years old. And, polymyalgia rheumatica (PMR) and giant cell (temporal) arteritis are more common as a person gets older. The same is true for rheumatoid arthritis (RA), but it is also more common in women.
A person with symptoms of an inflammatory rheumatic condition should contact their doctor as soon as possible.
The symptoms depend on which condition is present. Along with severe back pain (and other joint pain), common symptoms include morning stiffness, trouble moving the back or other joints, headaches, tiredness, trouble with eyesight, weight loss, and fever.
A person with symptoms of an inflammatory rheumatologic condition will have X-rays of the back and other areas of the body to look for changes. Blood tests are also common, in particular those that measure inflammation.
The doctor may refer individuals to a joint specialist or rheumatologist. Once diagnosed, treatment may include medicines to lessen pain and inflammation, as well as exercise, injections, physical and occupational therapy, and lifestyle changes to protect the joints.
A person with back pain, who is high-risk for a possible spinal infection, should contact a doctor as soon as they can. A spinal infection can either be in the bones or discs of the back.
High-risk means the person:
Has a suppressed immune system (for example, from long-term steroid treatment or from medicines to treat cancer or an autoimmune condition)
Had a recent infection in another part of the body
Had recent surgery or a procedure or surgery of the back
Uses or used intravenous (IV) drugs
Is currently on hemodialysis.
A person will have severe pain in the back. Other symptoms may include a fever, tenderness when touched in the area where the infection is located, and possibly weakness, numbness, or tingling of the arms or legs.
A person with a suspected spinal infection will have an MRI scan, as well as blood tests to detect and determine the location and type of infection. Treatment depends on the severity of the infection and may include referral to specialists, hospitalization, intravenous antibiotics, or surgery.
8. Thoracic Outlet Syndrome
Thoracic outlet syndrome (TOS) describes several disorders involving the arteries, veins, or nerves in the thoracic outlet. The thoracic outlet is the narrow area between the collarbone (clavicle) and first rib on each side of the body.
A person with symptoms of TOS should contact their doctor.
Depending on the structures involved, symptoms vary. In addition to one-sided neck and shoulder pain, they include weakness, numbness, tingling, and swelling of the arm. The hand may also be pale and cold. When raising the arm from a resting position, the arm and hand may change color.
A person with symptoms of TOS will be examined by their doctor for signs of TOS. Tests may include imaging and evaluation of the nerves or muscles. Treatment may be exercise, physical therapy, and medicines. Surgery is also a possibility.
9. Cauda Equina Syndrome
Cauda equina syndrome is a rare condition affecting the bundle of nerve roots just below the spinal cord in the lower back. If untreated, it can cause permanent damage - that is what makes it a surgical emergency. A person with symptoms of cauda equina syndrome should go to an emergency department or call 911.
In addition to severe back pain, other symptoms include: severe pain in the buttocks and legs; sudden weakness and change in sensation in the legs; inability to hold urine or bowel movements (incontinence); inability to urinate or have bowel movements (retention); numbness in the buttocks and upper thighs (saddle anesthesia); and, in males, inability to maintain an erection.
A person suspected of having cauda equina syndrome will have an immediate MRI scan and an urgent referral to a surgical specialist. Surgery is usually required within 48 hours of symptoms developing.
Severe back pain may be due to recent or current cancer. Cancerous tumors may involve the back or they may be located in other parts of the body with pain that spreads (radiates) to the back.
Additionally, the bones of the spine are the most common place for cancer elsewhere in the body to spread or metastasize.
Those who do not have a recent or current diagnosis of cancer may be at increased risk if they are older, have a family history of cancer, or a history of tobacco use.
A person with a recent or current diagnosis of cancer should contact their doctor as soon as possible. A person with symptoms described below, without a recent or current diagnosis of cancer should contact their doctor's office for an appointment.
There may be severe or worsening back pain, as well as neurologic deficits like weakness, numbness, or tingling in the legs. Another common symptom is weight loss. A person may also have trouble sleeping, due to increasing pain.
When there is a current or recent cancer diagnosis, the person is usually referred to their cancer specialist or oncologist for pain management, further testing (imaging and blood tests), and treatment, as needed.
When there is severe back pain with a history of cancer in the past or risk factors for cancer, immediate imaging and blood tests are ordered. A referral to an oncologist or other specialist may be necessary.
Back pain is usually not something serious, although it is possible. If you have concerns about your back pain, please follow our guidance and call your doctor or get immediate medical care.