Lower Back Pain: When to Worry

Low back pain is the 5^th most common reason for visits to the doctor in the United States. Most individuals with low back pain have a simple disc herniation or muscle sprain and will experience significant or complete improvement within one month.

However, there are some causes of lower back pain that are serious, debilitating and potentially deadly. These causes include cancer, vertebral fractures, ankylosing spondylitis, cauda equina syndrome, severe spinal stenosis, and spinal infection. Fortunately, there are red flags (specific warning signs and symptoms) that allow physicians to distinguish between a worrisome cause of lower back pain and a self-resolving cause of back pain.

Worrisome Signs and Symptoms of Low Back Pain which should be evaluated appropriately by a qualified physician:

General, Non-Specific Red Flags:

-Severe pain during the night

-Pain worse at rest

-Pain worse in the supine position

-Weight loss, fever, chills

-Failure of conservative treatment

Red Flags for Cauda Equina Syndrome:

-Saddle anesthesia (numbness in the inner thighs and groin)

-New onset urinary retention or incontinence

-New onset fecal incontinence (leaking stool)

-Motor deficits (muscle weakness) at multiple levels

-Loss of sensation around anus and perineum

-Loss of rectal tone (anal sphincter laxity)

Red Flags for Spinal Tumor or Spinal Infection:

-Age less than 20 years or more than 50 years

-History of cancer (not including non-melanoma skin cancer)

-History of chronic infection or recent infection

-Immunosuppression (steroids, HIV positive)

-History of IV drug use

-Weight loss, fevers, chills, night sweats

Red Flags for Vertebral Compression Fracture:

-Major trauma (serious fall, car accident)

-Minor trauma with elderly, people with osteoporosis or history of steroid use

Red Flags for Ankylosing Spondylitis

-Alternating buttock pain

-Severe morning stiffness

-Improvement with exercise

-Younger age (usually teens to 20’s)

-Awakening due to low back pain during the second part of the night only

-Positive Shober’s test

Red Flags for Severe Spinal Stenosis:

-Radiating leg pain with nonspecific low back pain

-Older age

-Pseudoclaudication (burning in the buttock and thighs with walking or standing that improves with sitting or lying down)

-Association with Paget’s disease, acromegaly, hyperparathyroidism or Cushing’s syndrome)

Any individual with lower back pain who is experiencing one or more of the red flag signs and symptoms above should see his or her physician. If your physician suspects cauda equina syndrome you can expect to immediately be transported to the hospital for MRI and possible surgery. Cauda equina syndrome can cause paralysis of the lower half of the body if left untreated.

If your physician notes red flags associated with any of the other worrisome causes of lower back pain then you can expect to get imaging (ranging from x-ray to MRI) and blood drawn for labs. Never hesitate to see your doctor if you experience any of the red flags of lower back pain, it could save your life.