When Lower Back Pain is More Than Just Lower Back Pain: 7 Ways Back Pain Can Be Caused By Something Serious
Acute lower back pain is defined as a rapid onset of pain, stiffness, tension and discomfort. It is localised below the upper back/chest and above the glutes and can present with or without lower leg pain. Lower back pain is surprisingly common, affecting one-third of adults, with another third of them seeking advice from a health practitioner in any given year. Furthermore, the prevalence of individuals presenting with lower back pain has substantially increased globally, affecting 377 million in 1990 to 557 million in 2017. Most episodes of acute lower back pain self-resolve within two weeks, with a following 80-90% recovering fully within a 3-month timespan. We should not trivialise these cases, however due to the fact that many of them re-occur over time.
For most individuals with low back pain, a thorough history taking and clinical examination are sufficient, with most episodes described as non-specific back pain. However, a small percentage will fall into the category of serious pathology, meaning the origin of the lower back pain is much more sinister than something simple like a muscle sprain/strain.
Here are seven red flags to look out for when experiencing an episode of acute lower back pain:
1.) History of Cancer
For people with severe back pain, it is natural to wonder whether or not the pain might be a sign of spinal cancer. In most circumstances, acute lower back pain is rarely a sign of tumours or cancer. Certain predispositions (>50 years of age, history of cancer, genetics, obesity, smoking) can increase the probability that your lower back pain is caused by cancer growth. There are a few cancers that can present with lower back pain, such as prostate and lung cancer; There are a couple that is specifically relevant to the lower back, such as a spinal tumour (a growth that develops within your spinal canal or within the bones of your spine) and a vertebral tumour (a growth affecting the bones or vertebrae of the spine).
The signs and symptoms of spinal/vertebral tumours can vary depending on the type and the stage of development however, some tell-tale symptoms include:
Pain at the site of the tumour due to tumour growth. Back pain, often radiating to other parts of your body. Feeling less sensitive to pain, heat and cold. Loss of bowel or bladder function. Difficulty walking, sometimes leading to falls. Back pain that’s worse at night. Loss of sensation or muscle weakness, especially in your arms or legs. Muscle weakness may be mild or severe in different parts of your body.
There are many causes of acute lower back pain, with the significant majority unrelated to spinal/vertebral tumour growth. However, keep an eye out for symptoms, including:
– It’s persistent and progressive
– It’s not activity related.
– It gets worse at night.
– You have a history of cancer and develop new back pain.
– You have other cancer symptoms, such as nausea, vomiting or dizziness.
Seek immediate medical attention if you experience:
Progressive muscle weakness or numbness in your legs or arms or changes in bowel or bladder function.
2.) Age <20 Years, or New Back Pain Age >50 years
One particular red flag when treating an individual within these age brackets is the risk of a client having lumbar spondylosis, a general term to describe an array of conditions affecting the discs, vertebral bodies, and/or associated joints of the lumbar spine. The lumbar region is the most affected because of the exposure to mechanical stress. Spondylosis is common and worsens with age, mainly due to daily use. However, degenerative changes may appear in young individuals without trauma history.
What to do:
Lumbar Spondylosis is a complicated diagnosis. In many cases, individuals are symptom-free, and no specific treatment is required. However, keeping track of other symptoms that may have started at the same time as the lower back pain can help ensure best practices in your treatment.
Physical Trauma
Physical trauma is defined as a serious injury to the body. Two main types of physical trauma include:
Blunt force trauma—when an object or force strikes the body, often causing concussions, deep cuts, or broken bones. Penetrating trauma—when an object pierces the skin or body, usually creating an open wound.
Coming from a Paramedic background, I can relay that in the event of trauma, our concerns (as paramedics) can range from Traumatic Brain Injuries (TBI’s), limb Injuries, dislocations, concussions, spinal cord injuries and a whole lot more. However, in the therapeutic pain Management world, when considering trauma in lower back pain, our biggest cause for concern is the possibility of a fracture, specifically within the spine. Minor traumatic events (such as a simple fall) with the elderly can increase this risk substantially due to the bony changes associated with aging, predominantly osteoporosis.
What to do:
In such circumstances, mentioning to your practitioner any kind of traumatic event that may have led to your lower back pain can help give a clear snapshot of its origin, allowing for further radiological evaluation such as a CT/MRI Scan when needed.
3.) Physical Trauma
Physical trauma is defined as a serious injury to the body. Two main types of physical trauma include:
Blunt force trauma—when an object or force strikes the body, often causing concussions, deep cuts, or broken bones. Penetrating trauma—when an object pierces the skin or body, usually creating an open wound.
Coming from a Paramedic background, I can relay that in the event of trauma, our concerns (as paramedics) can range from Traumatic Brain Injuries (TBI’s), limb Injuries, dislocations, concussions, spinal cord injuries and a whole lot more. However, in the therapeutic pain Management world, when considering trauma in lower back pain, our biggest cause for concern is the possibility of a fracture, specifically within the spine. Minor traumatic events (such as a simple fall) with the elderly can increase this risk substantially due to the bony changes associated with aging, predominantly osteoporosis.
What to do:
In such circumstances, mentioning to your practitioner any kind of traumatic event that may have led to your lower back pain can help give a clear snapshot of its origin, allowing for further radiological evaluation such as a CT/MRI Scan when needed.
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
Pain is a symptom. Symptoms are the feedback that the body generates when it faces problems with its delicate internal balance (homeostasis). Without symptoms like pain, thirst, nausea and fevers, it would be very difficult for us to maintain a healthy body in the same way that it would be hard to drive a car safely with no dashboard display.
John is one of those rare gentlemen who has continued to play competitive soccer well into his late 50s. He is in really good shape, which you need to be to play football at that age—good shape except for his left leg. His left leg is not in good condition at all. In fact, once you get to know his left leg a bit better, it becomes apparent that it’s miraculous that he’s able to run at all, Let alone the type of running required to play competitive soccer against younger men.
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