When to Go to the ER for Back Pain: 5 Warning Signs

Key takeaways:

• Many cases of back pain can be managed conservatively at home and do not require a trip to the emergency room.
• Severe, sudden-onset pain or pain following a significant injury, fall, or motor vehicle accident should be seen in the emergency room.
• Loss of control over the bowels or bladder or loss of sensation in the extremities are considered red-flag symptoms that need emergent evaluation.

Back pain is one of the most common reasons for patients to seek medical care, but not all back pain requires a visit to the emergency room. While many cases of back pain can be managed with rest, over-the-counter medications, and conservative treatment, there are situations where the pain may signal something more serious. Knowing when your back pain signals a potential medical emergency can help you get the proper care. In this article, we will outline symptoms, situations, and red-flags that may require you to go to the ER for back pain.

When to go to the emergency room for back pain

While not all causes of back pain should prompt you to run to the emergency room, there are some situations to be aware of that indicate prompt care is needed.

1. Pain after a fall or injury

If you have experienced a fall or another significant injury and are now dealing with severe back pain, it is appropriate to be evaluated in the emergency room. Severe pain following an injury may be a sign of a spinal fracture, dislocation, or spinal cord injury. Untreated spinal fractures can lead to nerve damage, loss of mobility, and in severe cases can even cause permanent paralysis. Early detection through imaging tests such as X-rays or CT scans (which can often only be obtained and read same-day when you visit an emergency room) can prevent further injury by ensuring prompt treatment.

2. Pain after a motor vehicle accident

Similar to pain after a fall or injury discussed above, motor vehicle accidents can lead to significant spinal injuries that need prompt intervention. Motor vehicle accidents can cause back pain that ranges from muscle spasming due to whiplash, to spinal fractures, to spinal cord injuries that can cause paralysis if not treated properly and promptly. Many car insurance claims only provide coverage for a short window of time following an accident which is another reason why it is important to get immediate care after a car accident.

3. Loss of control over bowel or bladder

Cauda equina syndrome is a medical emergency that involves compression or damage to the bundle of nerves at the end of the spinal cord known as the cauda equina. These nerves control many important functions, including sensation and movement in the lower limbs, bladder, and bowels. When the cauda equina is compressed, it can lead to a range of serious symptoms, including burning lower back pain, numbness, weakness, and incontinence. If you are experiencing this symptom, it must be evaluated immediately in the emergency room.

4. Numbness, tingling, or weakness in the extremities

Not all cases of tingling and pins-and-needles are serious. For example, sciatica is an uncomfortable symptom that occurs due to a nerve impingement but isn’t considered an emergency. However, most cases of back pain that are accompanied by numbness, tingling, or weakness in the legs or arms should be taken seriously as these symptoms may suggest nerve involvement known as radiculopathy. Herniated discs in the neck and lower back, spinal stenosis, sciatica, and piriformis syndrome can all lead to nerve compression. Nerve involvement can lead to permanent nerve damage if not addressed in a timely manner.

5. Sudden-onset, intense pain

If you experience sudden-onset intense pain with no obvious cause (meaning there was no preceding fall, injury, or motor vehicle accident), it is possible that your back pain is not actually coming from the back. Kidney stones and kidney infections are often associated with back pain that comes on in intense and sudden waves. Rupture of an abdominal aortic aneurysm often presents with back and flank pain as one of its classic symptoms and has an almost 100% mortality rate if not caught and treated emergently.

Going to urgent care, a doctor’s appointment, or the emergency room for back pain

Deciding which medical facility to visit when you are experiencing back pain can be confusing. Knowing where to go for certain symptoms can help you receive timely and appropriate workup and treatment.

• Primary care doctor appointments are ideal for ongoing pain that is not severe but is persistent and not responding to conservative measures. Primary care is also appropriate for those with chronic back pain who need a treatment plan or prescription for therapy. Your doctor may also refer you to a specialist if needed.
• Urgent care visits are appropriate if your pain is moderate but does not involve neurological symptoms like weakness, numbness, or loss of bladder or bowel control. These facilities can often offer X-rays, prescriptions for pain relief and muscle relaxers, and may even be able to write a prescription for physical therapy or refer you to a specialist. Some urgent cares may even have the capability to see back pain that is the result of minor work-related injuries or motor vehicle accidents.
• If you are experiencing neurological symptoms, loss of control over the bowel or bladder, or if the pain is the result of a significant injury or motor vehicle accident, the emergency room is the most appropriate place to be seen. Additionally, severe and sudden-onset back pain with no obvious musculoskeletal cause should also be seen in the emergency room to rule out other life-threatening conditions such as a rupture of an abdominal aortic aneurysm.

How emergency room providers can help treat back pain

Unlike primary care offices and many urgent care locations, the emergency room has the added benefit of being able to go beyond performing the standard physical exam and order additional tests such as CT scans, ultrasounds, labs, and X-rays and receive results the same day. This allows emergency room providers to have a better idea of what they are dealing with and create a treatment plan accordingly. Treatment will vary based on the underlying cause but pain management, referral to a specialist or physical therapy, or surgical intervention for unstable fractures and spinal cord injuries are some of the most common approaches emergency room providers take when managing back pain.

Questions to ask your emergency room providers about back pain

• Do I need any imaging studies like an X-ray or an MRI?
• Will I need to follow-up with a specialist after this visit?
• What treatment options are available for my pain?
• Are there any red-flag symptoms that I should look out for that would signal the need to return to the emergency room?

Frequently asked questions: going to the emergency room for back pain

It is common for patients to have questions regarding how to handle their back pain and whether they need to go to the emergency room or wait to see their primary care provider. Below are answers to some of the most frequently asked questions regarding visiting the emergency room for back pain.

How bad should your back pain be before you go to the emergency room?

Quantifying how bad your back pain is will vary from one person to the next, so you should base your decision on additional criteria when deciding whether to be seen in the ER. You should go to the emergency room for back pain if it is severe, sudden in onset, accompanied by other alarming symptoms such as numbness or weakness in the extremities, or loss of bladder or bowel control, or if back pain follows a traumatic injury or accident. Minor back pain does not require a visit to the emergency room.

How can an emergency room visit help treat lower back pain?

The emergency room has the added advantage of being able to quickly diagnose the cause of back pain when compared to other medical offices such as an urgent care or primary care office. They are also able to provide pain management on site and refer for urgent surgical procedures if warranted.

Conclusion

Back pain is a common medical complaint, but there are times when it should be considered a medical emergency. Recognizing the warning signs of serious conditions such as nerve compression, infections, spinal fractures or spinal cord injuries can help you seek the right care at the right time in the right place. If you experience severe, sudden-onset back pain with any of the red-flag symptoms reviewed in this article or if you experience back pain after a fall, injury, or motor vehicle accident, the emergency room is the place you should be.

General Medicine follows a strict editorial process, including using real experts to write our articles, vetted primary sources, fact-checking, a secondary medical review, and updates as necessary. This article was medically reviewed and fact checked by Dr. Lane Thaut, DO.

Sources

Alexander, Christopher E., et al. “Lumbosacral Radiculopathy.” StatPearls, StatPearls Publishing, 27 February 2024. https://pubmed.ncbi.nlm.nih.gov/28613587/

Jeanmonod, Donald, et al. “Abdominal Aortic Aneurysm Rupture.” StatPearls, StatPearls Publishing, 8 August 2023. https://pubmed.ncbi.nlm.nih.gov/29083705/.

Rider, Loana S. and Erin M. Marra. “Cauda Equina and Conus Medullaris Syndromes.” StatPearls, StatPearls Publishing, 7 August 2023. https://pubmed.ncbi.nlm.nih.gov/30725885/