9 Signs Your Back Pain Is Actually an Emergency
Medical experts reveal the signs and symptoms that indicate your back pain may actually be an emergency.
Back pain is more common than you think
Does your back hurt? You’re not alone. Over half of American adults report having back pain every year and it’s estimated that over 80 percent of people will experience a problem with back pain during their lives, according to the American Chiropractic Association. And we’re not just talking aches and pains, back issues can be serious. Low back pain is the single leading cause of disability worldwide and is the second most common reason for visits to the doctor’s office, outnumbered only by upper-respiratory infections, according to the most current Global Burden of Disease report published in The Lancet.
The two types of back pain
But while back pain is very real and can be quite debilitating, the good news is that most cases of back pain are mechanical or non-organic—meaning they are not caused by serious conditions but rather things like a sports injury or bad posture. However, there are times when back pain can indicate an underlying issue that needs immediate attention, says Neel Anand, MD, professor of orthopaedic surgery and director of spine trauma at Cedars-Sinai Spine Center in Los Angeles. “It’s important to know the difference between ‘I overdid it at the gym’ pain and ‘bad’ pain,” he says. “Back pain that doesn’t go away or start to feel better after a few days, intensifies, or is excruciating is always a bad sign and needs to be taken seriously. Call your doctor right away.” (Here’s how to use a pain scale to assess your pain level.)
You recently injured your back
If you are in a car accident or other serious event, it’s common practice to get your back and neck checked out but many people don’t realize they can sustain serious injuries from less drastic events. “If your pain is far more than you’d expect, if it feels worse over time instead of better, or is incredibly painful, get it checked out, even if you think it’s minor,” Dr. Anand says. Whenever you directly injure your back it’s possible to have a spinal injury. Another possibility is a “pathological fracture” where a tumor has weakened your spine and then it fractures during a relatively small event, he explains. “Sometimes this type of back pain is the way people learn they have cancer,” he adds. (Learn the things pain doctors won’t tell you.)
You’re losing weight
Rapid, unexplained weight loss is never a good sign. And when it’s accompanied by back pain, it could be a sign of a tumor in the spine, says Neelima Denduluri, MD, a medical oncologist in Virginia, a clinical assistant professor at Georgetown University Medical Center, and the associate chair of The US Oncology Network Breast Committee. Cancerous tumors that press on the spine can also affect your stomach, making you lose your appetite, she says. Some tumors start in the spine, but more often they spread there from another location, such as the lung, breast, kidney, and prostate—which makes getting treatment fast even more crucial.
You can’t control your bladder
Back pain combined with bladder or bowel incontinence, or a feeling of increasing weakness or numbness in the legs, pelvis, and hips, could be serious, says S. Adam Ramin, MD, a Los Angeles-based urologist, medical director of Urology Cancer Specialists, and assistant professor of surgery at City of Hope National Medical Center. These symptoms can indicate a variety of illnesses and conditions that need immediate attention including multiple sclerosis, some types of cancer, nerve damage, or an infection, he says. Another symptom of this type of nerve injury is if you have no feeling when you wipe with toilet paper. (Here are signs your upper back pain is something serious.)
Your pain wakes you up at night
Back pain from overuse or a small injury should feel better when you lie down and rest, Dr. Anand says. But if you can’t find any comfortable position and/or you can’t sleep because of the pain you need to call your doctor, he says. “This could be from any number of conditions and diseases but it’s very serious,” he explains. “If your pain is combined with a loss of appetite, fever, or weakness or numbness, get seen immediately.” (Here are some less urgent reasons you have back pain.)
You’ve got stomach pain too
Localized back pain will rarely migrate to the stomach. Stomach pain, however, can often be felt in the back, which means that your back pain could be originating from the abdomen, Dr. Anand says. Stomach pain accompanied by back pain can be caused by many different abdominal issues, including internal bleeding, cancer, or even an abdominal aortic aneurysm, according to the American Academy of Family Physicians. Acute lower back pain that does not follow an obvious trauma or movement associated with the onset of pain, can be a symptom of an enlargement of the aorta (large artery) in the abdomen, called an abdominal aortic aneurysm. If your pain is severe and continuous, get to the ER, says Dr. Anand.
You’re also having pain while peeing
Intense—some call it “screaming”—back pain is a telltale sign of a kidney stone trying to make it’s way through your ureter, says Dr. Ramin. If your back pain occurs in spasms and/or you feel pain when trying to urinate or notice blood in your urine, you may need to head to the ER to be diagnosed and treated, he says. You’ll likely be given painkillers and an IV to help flush out the stone.
You have osteoporosis
If you have known osteoporosis and your back pain comes on suddenly, you could have fractured a vertebrae. “Osteoporotic fractures, also known as insufficiency fractures, are very common in the elderly,” Dr. Anand says. “They may not even feel the break when it happens but the pain becomes debilitating over time.” Common causes could be a recent fall, lifting something heavy, or even a violent cough. (In the meantime, try these exercises that help relieve back pain.)
You’re experiencing numbness
If you’re experiencing back pain and numbness, especially in the legs, it may indicate an injury to one or more lumbar nerves, or spinal damage, Dr. Anand says. This can lead to paralysis if not treated in time. “Any neurological symptoms, like weakness or numbness, with back pain indicate something very serious and should never be ignored,” he says.
You feel a lump in your breast or armpit
Back pain can be a lesser known symptom of breast cancer, says Dr. Denduluri. Breast cancer can spread before it’s caught, causing symptoms in body parts that have nothing to do with your breasts, she says, adding that while it’s more common in women, men can also get breast cancer.
- American Chiropractic Association: "Back Pain Facts and Statistics"
- The Lancet: “Global Burden of Disease”
- Neel Anand, MD, professor of orthopaedic surgery and director of spine trauma at Cedars-Sinai Spine Center in Los Angeles
- Neelima Denduluri, MD, a medical oncologist in Virginia, a clinical assistant professor at Georgetown University Medical Center, and the associate chair of The US Oncology Network Breast Committee
- S. Adam Ramin, MD, a Los Angeles-based urologist, medical director of Urology Cancer Specialists, and assistant professor of surgery at City of Hope National Medical Center
- American Academy of Family Physicians: "Abdominal aortic aneurysm (AAA)"