Red flags for back pain

Most back pain is not dangerous and gets better within a few weeks. But in a small number of cases, back pain is a sign of a problem that needs treatment soon. Knowing these signs is like knowing the emergency number: you hope you will never need it, but if you do, you need to know it.

Level one: call 115 or go to an emergency department at once

115 is Iran’s emergency number. If you have back pain and any of these as well, do not wait for clinic hours:

• pain, tingling, weakness or numbness in both legs
• loss of feeling around the anus or genitals
• changes in passing urine or stool: trouble passing urine, being unable to pass urine, or leaking urine or stool
• losing the sense of needing to open your bowels
• a change of feeling during sex, or new trouble with erections

These two are emergencies as well, even if you have none of the signs above:

• back pain that began after a car crash or a heavy blow
• back pain together with chest pain

Do not drive yourself. Ask someone to take you or call an ambulance, and take your medicines with you.

Why do these matter?

The first list, which is bladder and bowel problems, numbness in the saddle area and weakness in both legs, may be a sign of cauda equina syndrome. This is rare: the nerves at the bottom of the spine are suddenly and severely squeezed. It needs emergency admission, and the longer it goes untreated the greater the chance of permanent paralysis and incontinence, and emergency surgery may be needed. That is why the decision has to be made at that moment, not tomorrow. Back pain after a heavy blow, and back pain with chest pain, are not signs of cauda equina syndrome, but they too need to be seen at once.

If you are in doubt about a sign you have, call the clinic.

Level two: the same day

If you have back pain and:

• you feel hot, cold, shivery or unwell
• the pain began suddenly and is severe, or is getting worse quickly

contact a doctor or the treatment team the same day. In these situations urgent assessment and imaging are also needed: significant weakness in a leg or arm, a history of cancer that has spread, a recent infection or fever with nerve pain, and pain after a fall or blow. If you have any of the level one signs, do not wait until the same day: call 115 at once.

If weakness in a leg or arm is getting worse, do not delay either.

Level three: as soon as you can (within a few days)

Make a doctor’s appointment for these signs:

• pain that has not improved after several weeks of home treatment
• pain that makes daily tasks hard
• worry about the pain, or not being able to cope with it
• weight loss with no reason
• a lump or swelling in the back, or a change in the shape of the back
• pain that does not ease with rest or is worse at night
• pain that gets worse with coughing, sneezing or opening the bowels
• pain that starts in the upper back (between the shoulder blades), not the lower back

What helps?

If you have none of the signs above, the advice is: stay active and carry on with daily activity, avoid long periods in bed, wrap an ice pack or hot pack in cloth, and ask a pharmacist or doctor about painkillers (anti-inflammatories do not suit everyone). Walking, swimming, yoga and Pilates may also help. More detail is in the article “Does back pain always need surgery?”.

If you are not sure

If you do not know which level your sign belongs to, call. An unneeded call does no harm; reporting late might. Every patient’s plan is different; ask your doctor about your own situation.