Low back pain is classified as acute (lasting less than 4 weeks), subacute (lasting 4-12 weeks) and chronic (lasting 12 weeks or more). Even though 84% of adults will develop back pain at some point in their lives, it is reassuring that for only 1% is life threatening systemic conditions.
The risk factors for developing low back pain are smoking, age, obesity, gender(being female), both sedentary lifestyle and physically strenuous work as well as psychologically strenuous work.
The red flags (this is the terminology that physicians use to signify things that should alert the physician that something serious may be causing the back pain) for low back pain are: new onset urinary retention, fecal incontinence, significant muscle weakness, having a history of cancer, fever and malaise. Other significant risk factors to be considered contributory are obviously severe trauma, presence of contusions and abrasions and prolonged use of corticosteroids, such asPrednisone and Methylprednisolone.
As serious as these symptoms may seem, the majority of patients will have ”nonspecific” low back pain, which means patients will have back pain that is not due to any specific underlying condition. Most of these cases are due to musculoskeletal pain that will improve within a few weeks.
As a result of these findings, radiological imaging is rarely needed unless the symptoms continue for more than 4 weeks or progress at any time. An additional consequence to imaging is that it may show abnormal findings that turn out to be not significant, but may lead further imaging or testing that was unnecessary, albeit warranted once the process is started. Interestingly enough, patients who have significant findings on radiology studies often times are asymptomatic. Patients who have seen me in the office often hear me say, that “medicine is not an exact science” and this is a clear example of this.
So, if you experience low back pain, when should you call in for an appointment to my primary care office? Certainly if you are having symptoms that significantly decrease your daily movement, contribute toloss of strength, loss of balance and fevers associated with lower back pain, you should certainly schedule an appointment with our office as soon as possible. Signs that things may be more serious and would warrant an ER visit would include fevers that are not improved with Tylenol or Ibuprofen, paralysis, inability to hold your urine or control your bowel movements and significant trauma. If ER physicians do not encounter any of these symptoms, patients may not even get a plain x-ray while they are in the ER and will be directed back to their PCP for further recommendations.
When low back pain persists for 4-6 weeks, plain x-rays can be used to show fractures, compression fractures, osteoarthritis, scoliosis and spondylolisthesis. Symptoms that are progressive or involve nerves may require an MRI, if plain x-rays are not conclusive. If a patient is unable to undergo an MRI, then a CT is ordered. There are additional imaging studies used to evaluate lower back pain, but they are used less frequently.
Thankfully, even though, there are very serious causes of lower back pain, the majority of cases can be treated in the primary care office with or without imaging. Most cases of lower back pain resolve within 4 weeks and do not proceed to become a chronic condition. More serious symptom certainly warrant a ER evaluation.