Here's When You Should Go to the ER for Lower Back Pain, According to Experts
Sudden lower back pain can be extremely debilitating and frightening. It can happen anywhere and anytime. Perhaps during a workout, one bad squat sent you into agony. Or maybe you picked up something heavy while doing chores, only to feel stabbing pain near your spine.
After the onset of the injury, you might find it difficult to stand up straight, to bend over and tie your shoes, climb stairs, or do any of your daily activities. Depending on your job, you may find you have to call in sick.
Put simply: Lower back pain feels dire. You might think, "How do I know I haven't done some serious damage?" or "Should I go to the emergency room?" The pain can be so intense that you might assume you have a herniated disc. (These occur when the gel-like cushions that sit between the vertebrae of the spine balloon out and irritate neighboring nerves.)
But before you start thinking you need to schedule surgery, know that most of the back aches that Americans experience are not about herniated discs, says Bill Rifkin, M.D., an internist who oversees guideline development for acute patient care at MCG Health. For one thing, spine abnormalities don't always equate to pain or surgery, and "the vast majority of back pain is not inherently dangerous in any way," he says. "But almost always, [back pain] gets better in somewhere between four and 12 weeks—often shorter."
This is because the most common causes of lower back pain are due to muscle and ligament strains, muscle fatigue, and lifestyle habits. These are things that can often be addressed with rest, ice, heat, and anti-inflammatory meds like ibuprofen, says Dr. Rifkin. In some cases, physical therapy or massage therapy—that's approved by your primary care doc—can help, too.
"There are really not a lot of reasons for when you need to go seek emergency care for low back pain," says Stacey Popko, a pediatrician, internist, and overseer of guideline development for ambulatory care at MCG. "Most of the time going to your primary care physician is really the best place to go."
However, there are some warning signs you should be aware of that may point towards a condition or illness that needs attention, stat. So to come up with the best guidelines, we talked to physicians at MCG Health: a company that compiles evidence-based, data-driven resources for countless health conditions to help patients and physicians work together to develop individualized care plans. Their experts told us the major red flags in back pain, when you should seek emergency care, and what to expect when you get there.
When You Should Go to the ER
Sometimes back pain just can't wait. For example, if you were in a major car accident, or fell from a dangerous height, you want to check for any fractures, ruptures, and dislocations. And while it's rare, lower back pain can be a symptom of more serious neurological issues, infection, cancer, and other worrisome conditions.
So get to an ER ASAP if any of these situations are true for you:
Have back pain associated with serious trauma (like an accident)
Have cancer or have a history of cancer
Have HIV/AIDs or are taking immunosuppressive drugs
Have trouble going to the bathroom or can't hold your urine or stool
Are experiencing neurological dysfunction like leg weakness or numbness
Lose sensation around the groin area
Have a fever in associated with your back pain
Have back pain that's worse when lying down
What to Expect When You're At the Hospital
When you arrive at the hospital, a emergency department (ED) clinician—either a doctor, nurse, or physician's assistant—will ask you a series of questions to figure out the source of the problem. They'll ask you how long you've been experiencing the symptoms and if you can identify anything specific causing the pain. They'll ask you about any signs that may indicate a more threatening condition (like the ones listed above).
Next, "the ED clinician will do a physical exam that will focus on looking for the most serious causes of low back pain," says Dr. Popko. "She will look for motor weakness in legs or arms, or sensory abnormalities, particularly in the genital or groin area. She is typically looking for serious spine conditions or non-spine conditions."
Spine conditions could include disc or nerve damage, while non-spine conditions could mean issues relating to the blood vessels near the spine.
If you've been experiencing back pain for less than six weeks and the doc doesn't note anything alarming, you most likely won't be sent for further testing. However, if your clinician does note something as a red flag, they may order you an ultrasound, CT scan, or whichever imaging they think is the most appropriate.
Questions to Ask Your Doctor
Whether you're seeing your primary care doctor or sitting in the emergency department, a clinician is going to tell you what they think is the best path for your treatment. They might suggest certain diagnostic tests, medication, or action steps based upon their understanding of the issue. But it's important to remember that health care is a team effort requiring the participation of the patient: you. MCG experts highly suggest that you ask questions so that you and your clinician can make empowered, informed decisions together. Here are some questions that you can bring with you to your clinic or hospital visit:
What is this test for?
How many times have you done this procedure?
When will I get my results?
Why do I need this treatment or drug?
Are there any alternatives?
Will this medicine interact with any meds I'm currently taking?
When and how should I take my medicine?
What should I do if I miss my dose?
What are the possible complications or side effects?
What can I do to help manage my care?
What should I avoid doing to prevent my back pain from getting worse?
What should I do if my symptoms start?
Where and when should I get help if I get worse?
Of course, this is not an exhaustive list so if there are any questions that come up for you before, after, or during the appointment, don't be afraid to ask. Back pain is frustrating, but you don't have to suffer alone.
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