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ER or Not: Severe Back Pain

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ER or Not: Severe Back Pain

May 11, 2018

Should you go to the ER for back pain? In this episode of ER or Not, emergency room physician Dr. Troy Madsen details the two symptoms you should be looking for that could be signs of something requiring immediate emergency care. The second one might surprise you.

Episode Transcript

Announcer: Is it bad enough to go to the emergency room? Or isn't it? You're listening to ER or Not on The Scope.

Interviewer: All right. Today's ER or Not, back pain. Should you go to the emergency room for back pain? Dr. Troy Madsen from University of Utah Health ER or Not.

Two Severe Back Pain Symptoms You Should Get ER Treatment For

Dr. Madsen: So this is going to come down to a few things, and these are basically a few things that you should go to the ER for. Number one, did your back pain start because you were directly injured on your back? That's something you should go to the ER for because you very well could have a spinal injury. That's a very serious thing.

Number two, are you having symptoms like, losing control of your bladder or your bowels? Maybe you didn't have a direct injury to the back, maybe you're just having pain in your lower back and you cannot get to the bathroom quickly enough, you just can't hold it, you're urinating on yourself or you try to go to the bathroom and you really can't urinate. That is something that also you need to go to the ER for.

So that's second thing, the first thing's probably kind of obvious, you figure, "Okay, if I've been injured, let's say I fell or something hit me on the back, I'm having pain right on my spine, probably need to get some X-rays or a CT scan," but the second thing it's kind of an unusual thing but something I always think about, It's a term, it's something medical condition called cauda equina, and what that means is cauda equina's Latin for the horse's tail.

So if you look at the spine it's just kind of a cord that goes down and then at the end of the spine it all spreads out and looks like a horse's tail. This is where all these nerves take off and spread out there. So down there at the bottom part of the spine, the low back, if you get a disc that's pushing in or something that's pushing in on the spine, that's a surgical emergency. You need to go to the operating room and get that repaired and treated and the typical symptoms that people have with that are low back pain, and then they say, "I cannot hold it, I can't get to the bathroom quickly enough," or, "When I try to go to the bathroom I just can't urinate, I feel like I have to go and nothing comes out."

In my mind, that really raises concern for that, and the way I diagnose that is an MRI. And that's something you would need in the ER. So those are the two things that would say go to the ER for.

Other Types of Back Pain

There are lots of other types of back pain, maybe you've lifted something, you've got a back strain or a sprain, maybe you've got a herniated disc. We do see lots of people with chronic back pain where it flares up. These are all things that could probably be treated through your primary care doctor or even through an urgent care. But in terms of the things that are really serious, those are the things I recommend watching for.

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updated: May 11, 2018
originally published: August 12, 2016