One of the first questions my patients ask about persistent or lingering back pain is, “Is my condition serious?” I use 4 questions to assess if lingering back pain is unlikely to resolve on its own or could be arising from a serious underlying medical condition.
Before You Continue
Keep in mind that back pain is incredibly common and normally goes away on it’s own. Here are a few key points:
- Back pain will affect 80% of people during their lifetimes.
- A very low percent of back pain is caused by a life-threatening condition.
- The vast majority of back pain will resolve on its own within 4 to 12 weeks.
Here are the questions you should ask yourself to assess if you should seek medical attention.
Question 1: Do I have red-flag symptoms?
If you have worrisome or “red flag” symptoms, you could be part of the 1% of the population with a severe underlying medical condition, such as metastatic cancer of the bone, bone infection ([wiki]osteomyelitis[/wiki]), or severe pinching of a nerve root ([wiki]radiculopathy[/wiki]). If you have any of the following symptoms, you should seek medical evaluation as soon as possible.
Red Flag Symptoms
- Inability to control your bowel or bladder
- Numbness or tingling in one or both legs
- Pain that started after trauma, such as a fall or car accident
- Intense, constant pain that becomes worse with rest or sleep
- Unexplained weight loss
- Pain associated with a throbbing sensation in your abdomen
- Pain that is also associated with a fever, night sweats, or chills
- Numbness in both thighs
- New or progressive weakness in the arms or legs
Question 2: How long has my pain been present?
Less than 4 weeks
Back pain that has been present for less than 4 weeks is considered “acute” back pain. Acute back pain is highly likely to resolve on its own without medical treatment. Patients with acute back pain usually do not require medical attention unless their back pain is highly debilitating, i.e, severely limiting your ability to perform daily tasks.
Just remember, severe pain (especially if it comes on quickly) is usually a warning sign from your body that something may be seriously damaged. If the pain is so severe that you can’t do normal daily activities like walk, get out of the car, or transition from standing to lying, then seek medical help.
Severe debilitating pain, especially if [wiki]bedridden[/wiki], can lead to serious downstream medical problems such as blood clots ([wiki]deep vein thrombosis[/wiki]), lung collapse ([wiki]atelectasis[/wiki]), and pneumonia. Sometimes severe pain, especially when it comes on quickly, can be related to a spinal [wiki]compression fracture[/wiki] or insufficiency fracture.
Longer than 4-12 weeks
If your back pain has lasted longer than 4 weeks, it could be time to see a specialist. Back pain lasting between 4-12 weeks is defined as “subacute” and back pain that has lasted longer than 12 weeks is considered “chronic.”
Generally speaking, the body should be able to heal itself within a 4-12 week period. If pain persists beyond the 4 week mark, evaluation by a physician is warranted to understand why your body is still sending pain signals to the brain. The longer your back pain lasts, the less likely it will resolve on its own.
Question 3: How severe is my back pain and is it getting worse?
If your back pain is becoming worse over time or severely limiting your daily activities, you should strongly consider scheduling a consultation with a medical specialist regardless of how long the pain has been present.
The natural course of back pain should be steady improvement over time. Worsening pain indicates that the underlying cause of pain is not resolving in the usual manner.
Ask yourself the following questions:
- “Is my pain significantly interfering with everyday activities?”
- “Over the last 7 to 10 days, am I noticing my pain more or less?”
If you answered yes to either question, consider a consultation with a medical specialist.
Question 4: Has my back pain improved with conservative treatments?
If you’ve tried over-the-counter medications, physical therapy, or other conservative therapies for over 6 weeks and you’re still in significant pain, it’s most likely time to be evaluated by a specialist.
Minimally invasive procedures such as steroid injections and nerve ablation can help patients achieve pain relief and avoid invasive surgical procedures.