Back pain is a common problem that can affect anyone at any time, even without prior injury.  According to Georgetown University, “Nearly 65 million Americans report a recent episode of back pain. Some 16 million adults — 8 percent of all adults — experience persistent or chronic back pain, and as a result are limited in certain everyday activities.” 

In addition, back pain is one of the top reasons people miss work. “Over 4 million adults report that they have had difficulties becoming or remaining employed due to back pain,” Georgetown University states. “It is the leading cause of work limitations among adults ages 18 to 64, reported by one in five. And among adults age 65 and older, back pain is the fourth leading cause of work limitations.”

Back pain can often reveal there’s a more serious underlying issue like a spine condition and  Dr. Ronald Barton Tolchin, medical director of the Spine Center with Baptist Health Miami Neuroscience Institute tells us, “People who are very young or very old and have back issues, should have a higher amount of scrutiny because it may indicate they have a serious spine condition. Overall, the red flags above may indicate a serious spine condition or individuals who have not responded to conservative spine treatment over a 4-6 week period may have a serious and debilitating back condition that requires further work-up and management.” 

He adds, ” The spine is the foundation and framework of your body. Exercise is key and regular movement is key to a healthy life. I encourage my patients to follow the American Heart Association‘s guidelines to exercise for at least 30 minutes most days of the week. Additionally, core strengthening exercises can help with maintaining a healthy spine, and it’s something we should all seek to do on a regular basis.”

Here’s six signs, according to Dr. Tolchin that indicate a serious spine condition. As always, please consult your physician for medical advice.   Read on—and to ensure your health and the health of others, don’t miss these Sure Signs You’ve Already Had COVID.

Dr. Tolchin explains, “This indicates that the patient can have a serious spine condition instead of a normal mechanical back pain. This is an individual who can’t find a good position to alleviate the pain – the pain is constant and unremitting. Cramping, dull, and achy pain can indicate mechanical pain such as muscle spasm, but if there is a serious condition with spine involvement then it will feel like a sharp, searing pain – it might feel electrical, unremitting, and constant, as well as unaffected by position changes.”

Dr. Tolchin says, “Severe spine conditions may show up as leg pain when the nerves get squeezed or compressed, also known as neurogenic claudication, which is typically caused by spinal stenosis. It can cause weakness in the lower extremities, especially in the feet, which may make someone prone to falls. Symptoms that differentiate the pain from normal back pain is that it shows up as numbness, tingling, or heaviness in the legs, e.g., nerve pain occurring in the buttocks that go to the calves and then into the feet.”6254a4d1642c605c54bf1cab17d50f1e

According to Dr. Tolchin, “Fever or chills can be a sign of a severe spinal condition and can also indicate a severe infection. If these symptoms persist, it means the patient needs emergency care.”

“Waking up from deep sleep in the middle of the night with severe back pain can indicate a serious spinal injury,” Dr. Tolchin shares. “Patients with mechanical back pain or arthritis can have trouble finding a comfortable position to sleep, but when there is night pain or even night sweats that wake the patient up from sleep, this can indicate a serious condition. Not only might this indicate a serious spinal issue, but it can also be a sign of something more serious such as cancer and requires a prompt and thorough investigation.  An individual with non-serious mechanical back pain can usually find a position of comfort and sleep through the night.”

According to Dr. Tolchin, “This happens mostly with different types of cancer, especially with metastatic cancer that goes into the spine. Those individuals with back pain who eat well but still lose weight without any reason, should seek medical attention.”

Dr. Tolchin explains, “Bowel and bladder incontinence can be a sign of a serious spine issue, this lack of control can happen when there is a very large disk herniation that puts pressure on multiple nerves or other serious conditions of the spine causing nerve root pressure. This causes the patient to lose control of his/her bladder or even may experience urinary retention where they cannot urinate.”

Dr. Tolchin tells us, “Back pain can certainly be a warning that there is a problem; however, in many cases, it starts when the patient gets older due to degenerative changes in the lumbar spine, affecting the discs that separate the vertebral bodies (the support structures of the spine). We do know that the spine will degenerate with age. This is due to the cartilage between the vertebral bodies wearing out. This cartilage is called an intervertebral disc. It has a component of cartilage around the outside and – a soft gel like material on the inside called the nucleus. With age, this dries out and this can cause tears or cracks in the outer part of the disc creating disk herniation and can cause severe back pain. This can happen in the elderly, as well as in young people. The herniated disc is an example of an acute back injury, but can also be a serious spine condition.

Other examples of debilitating pain can be a condition called spinal stenosis. This is where there is narrowing of the spinal canal around the nerve roots, causing pressure due to arthritic changes over time. This usually happens with older adults. Initially, it may start with back pain; however, as the condition worsens, individuals have both weakness, fatigue, and sensory loss in the lower extremities, which can be profoundly debilitating. This is not an acute onset of pain, but rather it is gradual as the arthritis occurs. The individual will have to stop walking as the legs fatigue and then sit back down, which can temporarily help with recovery. Additionally, actively bending forward will open the canal, allowing the nerves to recover, such as when sitting down.

Different types of cancer, especially lymphomas, prostate, and breast cancer, can also spread to the bones, and manifest as back pain. As we observe Breast Cancer Awareness Month, the spine is one of the places where breast cancer can spread and metastasize. Clinicians need to be mindful of this when examining and working up patients at risk.

Another cause of severe back pain can be due to osteoporotic compression fractures, where bones are easily compressed and can happen either with a fall or by bending over the wrong way. How severe depends on how demineralized the bones are and how advanced the osteoporosis is. Compression fractures are usually most common in the elderly, post-menopausal female with known osteoporosis, but can also happen to younger people if they have a serious fall or a serious impact even without osteoporosis.

Infections in the spine are another serious cause of low back pain. For example, discitis, which is an infection of the disc of the spine and can eventually lead to a pocket of infection known as an abscess.”