When is back pain an emergency?

Most back pain is not an emergency

Serious causes are uncommon. The NHS says that, very rarely, back pain can be a sign of a serious problem such as a broken bone, cancer or an infection, and that back pain often gets better on its own. Knowing the warning signs is still worthwhile, because a few of them call for fast action. The sources below describe three levels of response: a GP appointment, an urgent GP appointment or call to 111, and an emergency call to 999 or a visit to A&E.

Signs that need emergency care

The NHS advises calling 999 or going to A&E (accident and emergency) for back pain together with any of these:

• pain, tingling, weakness or numbness in both legs
• loss of feeling around the genitals or anus
• changes in bladder or bowel control, such as difficulty urinating or passing urine or stool without meaning to
• changes in how the genitals feel during sex, or difficulty getting or keeping an erection or reaching orgasm
• chest pain
• pain that started after a serious accident, such as a car accident

The NHS adds that you should not drive yourself to A&E. It advises asking someone else to drive or calling 999 for an ambulance, and bringing any medicines you take. Outside the UK, use your local emergency number. MedlinePlus lists similar warning signs, including being unable to pass or control urine or stool, a leg that is numb or weak and getting worse, difficulty walking and loss of balance, and a recent serious fall or injury.

What cauda equina syndrome is

Several of the signs above point to cauda equina syndrome. Cleveland Clinic explains that the cauda equina is a bundle of nerve roots at the bottom of the spinal cord, Latin for "horse's tail", which lets you move and feel your legs and bladder. When something presses on these nerves, the result is called cauda equina syndrome. The most common cause is a herniated lumbar disc, which is the same problem as a slipped disc (see What is a slipped disc?). Infection, injury, spinal stenosis and tumors can also cause it.

Cleveland Clinic describes it as a medical emergency. Symptoms can include back pain or leg pain (sciatica), leg weakness, numbness or tingling in the backs of the legs, buttocks and inner thighs, loss of bladder or bowel control, and being unable to pass urine. It estimates that the condition affects 1 in 30,000 to 100,000 people per year worldwide, and that it occurs in about 3% of disc herniation injuries. Treatment is surgery to relieve the pressure, and Cleveland Clinic says that when symptoms start suddenly the surgery is likely needed within 24 to 48 hours. If treatment is quick, permanent nerve damage may be prevented, but damage that has already happened cannot be reversed. Delay can lead to lasting problems such as loss of bladder or bowel control, sexual dysfunction or leg paralysis.

Other situations that need prompt attention

The NHS also advises an urgent GP appointment or a call to 111 for back pain with a fever or feeling hot, cold, shivery or generally unwell, or for severe pain that starts suddenly or is getting worse quickly. Mayo Clinic recommends seeking immediate care for back pain with new bowel or bladder problems, a fever, or after a fall, a blow to the back or another injury. The NICE guideline NG59 tells clinicians to think about alternative diagnoses and to exclude specific causes such as cancer, infection, trauma or inflammatory disease. For how scans fit into this, see Do I need an MRI or X-ray for back pain? The wider Back pain basics collection covers everyday back pain.

When to get help

Do not wait to see whether emergency symptoms settle. If any of the signs listed under emergency care appear, the NHS advice is to call 999 or go to A&E, and Cleveland Clinic advises going to the emergency room right away for these symptoms. For back pain without those signs, the NHS suggests seeing a GP if it does not improve after a few weeks of home care, stops you doing daily activities, comes with unexplained weight loss, a lump or a change in the shape of the back, or is worse at night. Advice and services differ between countries and between clinicians. This page is general education and is not personal medical advice, and it cannot tell you whether your own symptoms are an emergency.