Although rare, severe pain in the lower back may signify a medical emergency

Although one may experience severe pain in the lower back, the vast majority of back pain is not related to a medical emergency and will resolve on its own in a short period of time.

Most back pain can be effectively treated with conservation intervention such as medication, physical therapy, or some of the alternative medicine approaches like meditation techniques, yoga, and deep breathing exercises.

There are, however, some conditions for which you should seek immediate medical attention. These include:

  1. Fever with intense back pain
  2. Inability to manage daily activities
  3. Numbness in the saddle area
  4. Changes in bowel and bladder function
  5. Unsteadiness while standing

When Back Pain May Be A Medical Emergency

Dr. Ben-Yishay, a board-certified, fellowship trained spine surgeon in New Jersey, writes a nice article on medical emergencies related to back pain.

Fever (defined as a sustained temperature of more than 101° in adults) can indicate an infection. In the spine an infection can arise gradually if the immune system has been weakened, or it can occur following surgery. Although relatively rare, spinal infections can give rise to an epidural abscess (a pus-filled cavity in the epidural space) that can press on the nerve structures in the cervical spine (neck) or thoracic spine (upper back). This can impair gross motor skills, and result in paraplegia or quadriplegia.

Most infections can be treated successfully with antibiotics if brought to the attention of a physician.

  • Post-surgical or wound infections occur in about 1% of patients, and more frequently in diabetics or people in poor health. An infection may develop 1 to 2 weeks after the procedure, even as pain from the surgery is abating. The most common infection is a wound infection, which results in a fever of greater than 101 degrees, increased redness and pain around the incision, and a change in drainage from the wound, such as clear discharge becoming yellow and thick and the wound not closing.
  • A vertebral body infection (called vertebral osteomyelitis, or bone infection) spreads to the spine by veins carrying bacteria generated in other parts of the body. This kind of infection could arise after a urologic procedure such as a colonoscopy or a cystoscopy, a diagnostic test using a thin telescope to inspect the bladder, often prescribed when there is blood in the urine or before prostate surgery. Other conditions that make a vertebral body infection more likely are intravenous drug abuse, or long-term use of epidural steroids (e.g. to treat rheumatoid arthritis), because both of these activities increase the chances that bacteria will be introduced to the body.

Patients who experience sudden bladder and/or bowel incontinence (dysfunction that causes retention of urine, inability to hold urine in, or loss of rectal control), or feel progressive weakness or numbness in the hips and legs should seek immediate medical attention. These symptoms are indicative of cauda equina syndrome, which is usually caused by a compressed nerve in the lower spine.

Typical symptoms include:

  • Severe or progressive weakness, numbness or altered sensation in the lower extremities – the legs and/or feet
  • Loss of sensation or altered sensation in the “saddle” area (the area where a body is positioned on a saddle: inner thighs/between the legs, buttocks, back of legs, sacral region)
  • Difficulty walking without stumbling because of pain or numbness or weakness in one or both legs

Left untreated, cauda equina syndrome can result in paralysis, or loss of sensation in areas below the lumbar spine if the nerve is permanently damaged.
(More on Medical Emergencies)

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