When Back Pain is Serious

Sometimes Back Pain Requires Immediate Treatment

Almost two-thirds of adults in the United States will suffer from back pain at some point. Fortunately, most of the time that pain is due to a straightforward problem such as a herniated disc or degenerative disease in the spine. These problems are bothersome, and can even be dangerous if too much time is allowed to pass, but they are not considered a medical emergency.

On the other hand, any time back pain is associated with weakness or loss of bladder or bowel control, it should be considered an emergency that requires immediate treatment.

These symptoms can suggest compression of the spinal cord or cauda equina. Moreover, sometimes back pain can be a sign of more significant trouble. Here are some of the most serious causes of back pain that both doctors and patients must be careful not to miss.


Osteomyelitis is an infection of bone, usually due to an invasive bacteria. The bacteria can be difficult for antibiotics to treat adequately, and a long course may be needed. In some cases, surgery may also be needed.

Epidural Abscess

An abscess is a collection of pus that results from a local infection. When this occurs in the epidural space in the meningeal tissues that surround the spine, it can lead to spinal cord compression, with sensory loss, weakness, and impaired bladder control. Fever may or may not be present.

Primary or Metastatic Neoplasms

Cancer can cause back pain in a number of different ways. A metastasis may lead to compression in the spine.

Sometimes cancer can start in the spinal cord itself. Meningeal carcinomatosis can also cause back pain.

Lyme Disease

About 15 percent of people with Lyme disease develop neuroborreliosis, when the bacteria invades the nervous system. Back pain is a common first symptom, then more nonspecific changes occur, such as numbness or more.

It's important to mention, though, that chronic symptoms of Lyme disease are often over-diagnosed and treated with antibiotics despite there being very little evidence that such treatment is appropriate.

Spinal Card Infarction

Strokes occur outside the nervous system as well, and for all the same reasons. The spinal cord may have a vascular malformation, which could also predispose it to strokes.

Guillain-Barré syndrome

Guillain-Barré is usually thought of as a problem with the nerve roots near the spinal cord, which is frequently painful in addition to causing weakness.

Transverse Myelitis

The exact causes of transverse myelitis are uncertain, though most doctors believe that it is autoimmune in nature, similar to multiple sclerosis. People with transverse myelitis develop inflammation in the spinal cord in a matter of weeks or hours. Symptoms can include pain, weakness, sensory changes, and bladder or bowel dysfunction.

Referred Pain

A good doctor knows that when someone comes in for back pain, a thorough examination should be done, including the abdomen and other areas of the body.

This is because sometimes back pain results from a problem in another region of the body. This is known as referred pain. For example, either pancreatitis or an aortic dissection can spread to the back.


It's worth repeating that any time back pain is associated with new weakness or changes in bladder or bowel control, it's a sign that the nerves in the spinal cord may be seriously injured. Anyone with those symptoms should go to an emergency room immediately.

It's important not to lose sight of the fact that these causes of back pain, however frightening, are relatively rare. Most of the millions of people across the world who suffer from back pain will not have any of these diseases. That said, because these diseases are so serious, it is important that patients and doctors remember not to overlook them.


Blumenfeld H, Neuroanatomy through Clinical Cases. Sunderland: Sinauer Associates Publishers 2002.

Ropper AH, Samuels MA. Adams and Victor's Principles of Neurology, 9th ed: The McGraw-Hill Companies, Inc., 2009.

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