Back Pain - Is It Really Serious

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Back Pain - Is It Really Serious

When do I know that my back pain is really serious versus just run-of-the-mill back pain that will go away?

This is a question that most of us wonder about because almost all of us will have back pain at some point in our lives. In the vast majority of cases, we know that after a few days the back pain will go away and we can get back to our normal routine. In rare cases, however, there are more alarming symptoms that do need both the patient’s and the physician’s attention. I suggest to my patients that if they have back pain that either doesn’t go away after a few days, or is so severe that they cannot manage normal activities, (such as not being able to go to the bathroom, not being able to take care of meals, or not being able to walk around without assistance), they should consider a visit to their physician for an evaluation. Also, I tell patients that if they have any one of the serious signs of pain, such as new pain that shoots down a leg or arm, new weakness or numbness in a leg, arm or anywhere, then these are the kinds of symptoms that usually require immediate attention from a doctor.

Every now and then physicians see a case where pain is not just the routine ache in the back, but in fact, is due to something more serious. These cases may suggest that there is compromise, or potential compromise, within the nervous system and doctors may need to take more aggressive action, such as bringing the patient straight to surgery. In The War On Pain*, I described an example of this type of back pain, which, to the patient, did not seem so bad, but was actually a serious back injury that required emergent medical care. She described to me that her pain was shooting down her leg to the point to where her leg was weak, and it was numb. These symptoms told me that the nerves in her spinal cord were clearly being compromised and I urged her to see a neurosurgeon immediately. Within the next day, she was operated on to remove a fractured piece of bone from her spine that was pushing on her spinal cord. Had this piece of bone been allowed to persistently press on her spinal cord, it was possible that this could have caused serious and permanent neurological damage. Avoiding neurological damage to the nervous system can require quick and aggressive intervention.

In the vast majority of cases, (upward toward 90% of patients with back pain), I caution that there are not neurological signs with back pain. It is simply the kind of pain that I experience from time to time in my back, which seems to be caused from a sudden movement, or appears to have no particular precipitating event that brings out the irritating backache. It feels like either a muscle spasm or generalized soreness in the back, undermining one’s ability to move the back in its normal range of motion, or to even find a comfortable position while sitting, lying down, or standing.

In such cases, doctors find that patients do well by allowing their backs to be supported on a firm flat surface, with the knees bent and raised towards the chest. Often this can be accomplished when one sleeps, by wedging pillows under the knees, or by sleeping on one’s side with the knees bent, and placing a pillow between the legs.

In routine back pain cases, physicians no longer recommend to patients that they go straight to bed rest when their backs act up. This used to be the teaching doctrine by doctors in the older days, but now in the 21st Century, we know that actually becoming completely inactive is not necessarily a benefit. We also know that too much exercise and too much exertion can overstress the back, so physicians also usually don’t suggest going directly to physical exercise as a means to alleviate the pain. This may sound strange to some because many patients believe they can resolve their back pain by just increasing their exercise during a back pain episode, in effort to “work it out.” We now know that the best course of treatment is to moderate exercise, or modulate activities at a modest level that doesn’t cause pain or significantly stress the back in any way for a brief period of time while the back heals. Another important piece of information I give my patients is to neither overstress nor understress the body. It is often necessary to take a break from routine exercise but not routine activity, and, if possible, to avoid spending too much time in bed.

If pain lasts more than a few days, is so severe that it limits necessary activities of daily life, or shoots down the leg or arm, or numbness or weakness of a limb are present, I usually suggest a patient receive a full physical medical evaluation. This exam can be performed by one’s family doctor or an urgent care facility, as well as from other specialists.

I am often asked which doctor should be seen to diagnose and treat back pain and I believe that usually the family doctor or the primary care physician is the best first step. However, orthopedists, neurologists, neurosurgeons, rehabilitation specialists, or pain specialists, amongst others, can be very effective in examining a sore back. And of course, any back that continues to be sore after many days of modulated activities should also be evaluated by the patient’s physician.

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