Back Pain: When to Seek Medical Help

Most adults have back pain at some point in our lives – more than 90 percent of all U.S. adults, by some estimates. The majority of those people with back pain are able to treat it on their own with activity modification, Tylenol, or other non-steroidal anti-inflammatory drugs (NSAIDs).

For some people, however, that back pain will reach a point where it needs to be evaluated by a healthcare provider.

M. Gordon Whitbeck, Jr. MD, FAAOS, serves as Executive Medical Director of RRH Orthopedic & Sports Medicine, and Chair of the Department of Orthopedic Surgery at Rochester General Hospital. He explains what signs to look for with back pain that warrant a visit to a healthcare provider, what you can do to relieve that pain on your own, and what to expect if you are referred to a specialist.

When is back pain serious?

Back pain should be seen by a healthcare professional sooner rather than later if the pain meets specific criteria. This includes:

• younger patients with significant trauma or injury
• older patients with low back pain occurring spontaneously or with minimal injury
• any patient with neurologic pain (e.g., sciatic pain, weakness, numbness)

A particular concern is when back pain occurs in association with other symptoms or health conditions. Those might include:

• urinary/stool incontinence
• urinary retention
• constipation
• patients with cancer history
• significant or progressive neurologic symptoms (numbness, tingling, or weakness)
• fever/chills/sweats

“Patients who have these symptoms should be seen by their primary care provider immediately,” Dr. Whitbeck said.

Pain relief for mild back pain

Mild back pain can be treated initially with a mix of changes to lifestyle and at-home remedies. Some of these include:

• Modified or restricted activities
• Using ice or heat
• Over-the-counter analgesic medications (Tylenol, ibuprofen, etc.)
• Physical therapy

Providers will prescribe these measures for patients and see if they have any effect on their pain. If the pain persists after six weeks, then providers will consider imaging.

Next steps for diagnosing back pain

Patients with back pain will often ask ‘When should I get an imaging study done?’ and inquire about getting an x-ray or MRI scan to determine a potential cause.

Primary care providers often decide what type of imaging patients should receive and when it should be done. In most cases, primary care providers will refer patients for x-ray imaging. However, if there are serious neurologic symptoms or significant injuries, more advanced imaging such as an MRI may be ordered. In the event further evaluation or advanced imaging (such as an MRI) is warranted, they may refer directly to an orthopedic spine specialist.

Standard x-rays are done earlier for younger patients who have suffered a significant injury or trauma, or older patients due to increased likelihood that fragility fractures can occur with little to no injury.

“If someone has a long history of back problems, they may have a relationship with an orthopedic specialist,” Dr. Whitbeck said. “But you can always talk with your primary care provider about your back pain. You can never go wrong with that first point of contact.”