anxiety and environment

Back Pain Red Flags

Most cases of low back pain are acute and self-limited, resolving on their own within a few days without any permanent loss of function. In some cases, it may take a few months for the symptoms to disappear. Finally, in some cases, the pain persists, leading to chronic back pain.  

Are there any back pain red flags that suggest an underlying problem is more severe that requires medical advice? Let’s dive into some important details. 

When Is back pain a red flag?

  • The  low back  pain persists, gets worse and extends down the leg. It can feel like a sharp burning pain or an electric shock. The pain aggravates when you cough, sneeze or sit in a chair for long hours.It usually affects one site of the body.  These changes in your symptoms are highly suggestive that something is compressing the sciatic nerve. The sciatic nerve runs from the back to the leg and it can get inflamed and irritated most often due to a herniated disk. Excess weight, jobs that involve carrying heavy objects or twisting the spine, prolonged sitting, diabetes and age related degeneration are all risk factors for developing sciatica. Does the leg pain worsens when you leave the knee to the chest or bend over ? This is another clue that a herniated disk is compressing the sciatic nerve. Although sciatica can be managed at home with rest and antiinflammatory drugs, it can also cause complications. Seek medical advice as soon as possible if you experience weakness or loss of feeling in the affected leg, or if bowel or bladder function are impaired. 
  • Severe low back pain following a recent fall or trauma. You may guess what happened in this case: the spine and surrounding tissues likely  have been injured. Even falling down from a few steps can lead to a fracture in older adults, and should  be evaluated by a doctor right away. What everyone should know is that osteoporosis increases the risk of this injury. Therefore it is important not only to manage the back pain but also get a bone scan called DXA (dual-energy X-ray absorptiometry)to look for signs of osteoporosis. Treating osteoporosis helps prevent additional falls and injuries. 
  • Low back pain plus  fever or chills. While a flu can cause both fever and some muscle aches and pains, it usually improves with an antiinflammatory drug like acetaminophen (Tylenol). If Tylenol does not improve these two symptoms, or if they get worse, a serious infection could be the cause. A doctor will have to run some blood tests and  prescribe antibiotics if a systemic bacterial infection is confirmed. 
  • Back pain plus  numbness or weakness in your legs -especially  while walking

These problems suggest spinal stenosis, caused by narrowing of the spinal canal. A herniated disk can also cause numbness and tingling due to compression of the nerves. If left untreated, prolonged nerve irritation can lead to permanent disability and long-term problems. Important note: sudden weakness in the legs can also be due to a stroke which has to be treated urgently. 

  • Low back pain plus  incontinence. Loss of bowel or bladder control can be due to a serious nerve compression, or  infection like meningitis
  • Low back pain plus incontinence plus leg weakness plus numbness. These symptoms suggest cauda equina syndrome, a serious condition that leads to significant damage to the spinal cord nerve. Emergency surgery is required to decompress the nerves and decrease the risk of permanent nerve damage.
  • Low back pain plus unexplained weight loss. Losing weight despite eating as usual, along with back pain can be due to an infection or cancerous tumors, especially when fever is present as well. Infections are more likely to cause high fever, where cancer is more likely associated with low grade fever. The doctor will order some blood tests and MRI to rule out these conditions. In some cases of lung cancer, low back pain and weight loss could be the only early signs of this condition. 
  • Low back pain and  severe pain at night. If the pain is getting worse at night, or wakes you up in the middle of the night, there are a number of reasons. It could be due to a sprain or disc degeneration, but it could also be a more serious condition like cancer. Night pains should never be ignored. 


Some of the most important red flags are described above. Radiating pain, numbness, and tingling are all suggesting nerve involvement. On the other hand, if the pain is sharp rather than a dull ache, a torn muscle, ligament or a problem with a major organ from the abdomen or pelvis can be the cause. Night pain and unexplained weight loss can be due to cancer. 

Other symptoms may occur. As a general rule, if the low back doesn’t improve with rest, home remedies, and anti-inflammatories in a few weeks if new symptoms develop, or something just feels off, it is important to get evaluated by a doctor.