When is back pain an emergency?

Which back pain warning signs need a doctor this week?

Why this page is short and specific

Red-flag lists tend to grow until they cover most of human life. At that point they stop being useful and start being frightening. The list above is narrow on purpose. If none of it applies to you, the odds are strong that your back pain is mechanical, unpleasant and not dangerous. Then the right next question is which structure is causing it, not whether something sinister is happening.

Over-read this page rather than under-read it. Just do not carry it around as background dread. Those two things fit together: read it once, know what would change your plan, and then get on with the workup.

Why each item is on this list

Everything above is on this page because it changes what should happen next, not to create urgency around a service. When a finding points to an emergency department or to a surgeon, you are told that on the day, plainly, not after a course of something.

Not sure whether your back pain is serious?

Call and describe it. These are the specific things worth saying out loud, because they are the ones people leave out:

• Whether anything has changed about passing urine — including simply going less often, or having to strain.
• Whether the numbness is anywhere you would sit on.
• Whether the weakness is getting worse, staying the same, or getting better. The direction matters more than the amount.
• Whether you have had cancer, at any point, of any kind.
• Whether you have had a fever.

You can call or text us. If it is one of the emergency findings, do not call us first. Go.

Frequently asked questions

What are the five red flags of back pain?

The short list most clinicians work from is: bladder or bowel change, saddle numbness, progressive leg weakness, significant trauma, and infection or cancer features such as fever, unexplained weight loss or a cancer history. The first three together are cauda equina syndrome and are the true emergency.

How quickly does cauda equina need treating?

Urgently, in hours. Delay is associated with permanent loss of bladder, bowel and sexual function. That is the reason this is the one problem where the advice is to skip every normal pathway.

I have had back pain for years. Should I worry about this?

Long-standing mechanical back pain is not what this page is about. What matters is a change — a new neurological symptom, a new pattern, or a new severity that is unlike your usual. Chronicity (pain that has been there a long time) is reassuring; change is not. Three changes from your usual pattern are worth acting on, not waiting out.

Is severe pain itself a red flag?

Not on its own. How severe pain is says little about danger. Some of the most severe pain in this field comes from conditions that clear up completely. The red flags are about neurological function and whole-body illness, not about how intense the pain is.

What are the warning signs of cauda equina syndrome?

Three signs together point to cauda equina syndrome: new trouble passing urine or loss of bladder or bowel control, numbness in the saddle area, and weakness in both legs or one leg getting worse. The saddle area means the inner thighs, buttocks and genitals, or a changed feeling when you wipe. Trouble passing urine often comes before leaking and is easy to brush off. Any of these means the emergency department now.

Is back pain that wakes me at night a red flag?

It can be. Night pain that wakes you and does not ease when you change position belongs on the urgent list. That means being seen this week, not in a month. It is different from the ordinary discomfort of rolling over in bed. Urgent here does not mean the emergency department. It means an assessment with a low bar for imaging.

Does back pain with a fever need the emergency room?

Yes. Back pain with fever or shaking chills, back pain after a recent bloodstream infection, and back pain in someone who injects drugs all belong on the go-now list. Do not wait for an appointment or to see whether it settles overnight. When you call about any back pain, say whether you have had a fever, because it is one of the details people leave out.

At what age is new back pain a warning sign?

Back pain that starts for the first time before age twenty or after age fifty-five belongs on the urgent list. So does stiffness that keeps getting worse, with long-lasting morning symptoms, in a younger adult. That points toward inflammatory disease rather than mechanical pain. Neither needs the emergency department. Both need an assessment this week, with a low bar for imaging.

What causes leg weakness along with back pain?

Three different problems, and the pattern tells them apart. Weakness in one leg in a specific muscle group, such as a toe that catches or a heel that will not push off, is a compressed nerve root. Legs that grow heavy and weak with walking and recover when you sit point to spinal stenosis. Weakness in both legs with any bladder, bowel or saddle change is cauda equina and needs the emergency department now. Direction sets the urgency: weakness that is getting worse is seen the same day, and foot drop explains why weakness runs on a clock.

Related reading

• Lumbar radiculopathy
• Sciatica, and what impersonates it
• Spinal stenosis
• Before you agree to the operation
• Back pain doctor in St. Louis