4.) Unrelenting Back Pain or Pain that Worsens While Supine (lying on your back). 

With the development of acute lower back pain, one can obviously expect discomfort/soreness and a reduction in mobility. If the pain is severe and remains constant even in positional changes such as lying supine (on your back), it can signify a medical emergency that may become life-threatening or result in disability without prompt attention. One cause for concern that separates unrelenting back pain from other red flags is the possibility of Nephrolithiasis (Kidney Stones). There can often be a crossover of symptoms because kidney stones frequently cause lower back pain. 

What to do:

If you’re having symptoms of acute lower back pain that is relentless and non-alleviating, consider consulting Healthline to ensure that your symptoms aren’t mimicking a more serious condition that may require immediate hospital intervention.

5.) Widespread or Progressive Neurological Deficit

When hearing the phrase neurological deficit, one may assume a significant decline in an individual’s psychiatric state. The truth is a lot broader. A neurologic deficit refers to abnormal function of a body area. This altered function is due to injury to the brain, spinal cord, muscles, or nerves. Common symptoms of a Neurological Deficit include:

Urinary retention, Urinary and/or faecal incontinence. “Saddle anaesthesia” sensory disturbance can involve the anus, genitals and buttock region. Weakness or paralysis of usually more than one nerve root. The weakness can affect the lower extremities. Pain in the back and/or legs (also known as sciatica) or Sexual dysfunction.

While many diseases, syndromes, conditions and disorders can cause neurological deficit, one commonly appearing with acute lower back pain is Cauda Equina Syndrome. This rare disorder results in compression of the spinal nerve roots. Cauda Equina Syndrome (CES) is no joke; left untreated, CES can result in permanent paralysis and incontinence. After confirmed diagnosis with Magnetic Resonance Imaging (MRI) which creates a computer-generated image of bony structures and soft tissues such as muscles, ligaments, tendons, and blood vessels, urgent/emergent surgery is usually the treatment of choice with the goal is to free up the compressed nerve roots and give them the best chance of recovery.

What to do:

Similar to that other red flag recommendations, keeping track of other symptoms that may have manifested within the same time frame of your acute lower back pain can be paramount to correct diagnosis, therefore allowing early medical intervention. Cauda Equina Syndrome is something we are incredibly conscious of while treating our clients at Featherston Pain Clinic. When seeing us, don’t be afraid to state any of the aforementioned symptoms you may be experiencing.

6.) Systemic Involvement

In health terminology, systemic means affecting the entire body rather than a single organ or body part. One such circumstance of systemic involvement would be rheumatologic disorders such as Osteoporosis. A condition in which bone mass decreases, causing abnormality in the structure and strength of bone tissue, resulting in an increased risk of fracture. From a practitioner’s perspective, systemic involvement in acute lower back pain can be a symptom of a deeper problem rather than the main cause. 

What to do:

When considering your acute low back pain, be conscious of informing your practitioner of any genetic background, medical interventions, and health history that you may feel are pertinent.

7.) IV drug Use/ Immunocompromised/Steroid Use

You’re most likely thinking of illicit IV drug use. However, this goes into any circumstance where any medication/drug is given to an individual in an intravenous route. Furthermore, a recent study on the red flags for the early detection of spinal infection in back pain found that patients with immunocompromised conditions/diseases (diabetes, rheumatoid arthritis, lupus) were substantially at higher risk of developing a spinal infection. One common infection that can result in acute lower back pain is vertebral osteomyelitis, essentially causing inflammation or swelling of bone tissue that is usually the result of an infection. The veins in the lower spine (Batson’s plexus) drain into the pelvis and provide a direct route of entry for the bacteria to enter the spine.  

What to do:

Like other red flags of acute lower back pain, osteomyelitis can present with a rapid onset of lower back pain. However, most often, the condition presents other associated symptoms, including:

Fever, chills, or shakes, Unexplained weight loss. Nighttime pain is worse than daytime pain. Swelling and possible warmth and redness around the injection site. Recent colds/infections (including Covid-19)

When consulting with your practitioner about your lower back pain, ensure that you mention any recent IV medication/drug/steroid use (especially in chemotherapy). This allows us to make an informed decision on the best treatment.

Summary

Acute lower back pain affects people of all ages and contributes to disease burden worldwide. Managing your back pain should focus on ruling out any serious underlying causes and referring to a diagnostic workup or specialist referral when appropriate. In circumstances with no serious pathology, management through effective non-pharmacological therapies, education, analgesic medicines, and regular review create an effective treatment plan. 

If you have any questions regarding your low back pain, don’t hesitate to call us on 04-385 6446