When is Back Pain Serious?

Anyone who has ever experienced moderate or severe back pain could certainly make a good argument that his or her back pain was serious. On the other hand, most people who experience back pain gets better with little or no treatment. This suggests that most causes of back pain are, in fact, not serious.

When physicians and surgeons evaluate patients with back pain, they ask about certain signs and symptoms that indicate that back pain could be serious. They called the signs and symptoms “red flags” and they may indicate the need for more aggressive diagnostic testing, more aggressive treatment, and in some cases, emergency management.

Separating common back pain from serious back pain

Because back pain is extremely common and most people get better on their own, the first line of treatment is usually selective rest, ice and/or heat, and pain medicines. Some physical therapy or exercises may also be useful in providing relief from back pain.

But how do doctors know when a back pain is something more serious? They look for any indication that the back pain is going to cause serious or long-lasting consequences. For instance, anything that might paralyze a person from the waist down is very serious and permanent. Therefore, if back pain is caused by any of these things, the patient and the physician need to know about it and intervene as quickly as possible.

Back pain “red flags” requiring urgent or emergency medical attention

Some back pain red flags need to be dealt with immediately because they may lead to paralysis or other long-term consequences.

Cauda equina syndrome

One of these issues is called cauda equina syndrome. People with cauda equina syndrome may experience one or more of the following symptoms:

  • The inability to retain urine
  • The inability to urinate
  • A loss of feeling/sensation around the groin area
  • The inability to retain feces
  • Weakness, numbness, or tingling in both the legs
  • Weakness or numbness that is progressively getting worse

These back pain red flags are a medical emergency. Anyone who is experiencing one of these red flags should call 911 and be evaluated by a medical professional immediately.


When infection affects the spine, spinal cord, and surrounding structures, it can have devastating consequences. People who experience new back pain with a sustained fever over 100.4°F should be seen by medical professional immediately. New back pain with a fever is a red flag and potentially reflects a serious cause of back pain.

Likewise, any person with new back pain who has a depressed immune (e.g., HIV infection, treatment for cancer, taking steroids for autoimmune disease, etc.) should also be evaluated for possible spinal infection. Other people at risk are those with a history of intravenous drug use or recent bacterial infections such as urinary tract infection, pneumonia, or skin infection.

Traumatic spinal fracture

Back pain that occurs after a trauma to the spine may be caused by a vertebral fracture. The vertebrae are very stout bones and usually resistant to fracture. On the other hand, vertebrae may fracture if the trauma is especially severe (e.g., major car accident, fall from a height) or, with less trauma, if the patient has weak vertebral bones.

Who is more likely to have weak vertebral bones?

  • People with osteoporosis or osteopenia
  • People who take corticosteroids (i.e. steroids; prednisone) on a daily basis
  • Anyone over the age of 70

People with potentially weak vertebral bones who experience moderate or severe trauma should be evaluated for traumatic spinal fracture.

Back pain “red flags” requiring prompt medical attention

Not all back pain red flags are emergencies; however, if these red flags are present, the affected person should seek medical attention for complete back pain evaluation as soon as one can be scheduled.

Cancer-related back pain

Cancer is an infrequent, but serious cause of back pain. People over the age of 50 or under age 18 are at particular risk for cancer-related back pain. Weight loss in someone not trying to lose weight of greater than 20 pounds in six months is a red flag. Likewise back pain that mostly occurs at night or at rest is another red flag for cancer-related back pain.

Serious herniated disc

Not every herniated disc is considered “serious,” but some are. If the back pain, caused by a herniated disc, causes significant muscle weakness, this is a back pain red flag. Likewise, anyone with back pain who experiences foot drop (i.e., the foot cannot be flexed, the toes cannot be raised upward) may be experiencing a serious herniated disc and should be evaluated by a spine specialist or other healthcare professional.

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